Screening for COPD: the gap between logic and evidence

Abstract

Chronic obstructive pulmonary disease (COPD) is a common disease leading to further morbidity and significant mortality. The first step for any condition is to make the appropriate diagnosis, and spirometry barriers abound in practice around the world. It is tempting to undertake mass screening on all smokers to detect COPD. While this would pick up cases of COPD, results of studies of its effect on COPD end-points such as exacerbations, hospitalisations and mortality are disappointing. As such, aggressive case finding of COPD by screening for symptoms that patients may not themselves perceive is very important in primary care, with subsequent spirometry defining the diagnosis.We also have to separate out population screening from individual patient interactions. Performing spirometry, even on a truly asymptomatic patient, may allow earlier diagnosis and modification of risk factors such as smoking (mostly) and exacerbation risk. It also recognises patients with early disease who are at high risk of comorbidities such as cardiac illness, such that appropriate treatment strategies can be implemented. Making a diagnosis, and even the fact of worrying about such a diagnosis, can affect the motivational level of the individual patient to cease smoking; all patients should of course be counselled to stop smoking. As such, consider the individual patient in front of you for unrecognised symptoms and therefore unrecognised illness, as making a diagnosis earlier can allow the institution of care, including smoking cessation, vaccination, bronchodilators and comorbidity management.

Burden of comorbidities is higher among elderly survivors of oropharyngeal cancer compared with controls

“…COPD is a highly prevalent condition that is related to smoking and old age that confers significant morbidity and mortality, and the results of the current analysis demonstrated that survivors of OPC had twice the risk of developing COPD compared with controls. NCCN guidelines recommend computed tomography scans of the chest as clinically indicated during surveillance for patients with a smoking history . In addition, screening with spirometry is inexpensive and easily performed in a primary care setting.…”

Impact of the financial crisis on COPD burden: Greece as a case study

“…Secondary prevention aims to detect airway obstruction when it is still relatively mild and treatable [89]. Studies focusing on Greek primary healthcare settings reveal that COPD is mainly undiagnosed [33,[38][39][40][41]90].…”

“…Ideally, approaches to achieve the goal of early diagnosis in COPD need a major overhaul, and a culture change is required in primary-care settings. For this reason, a higher index of suspicion, as well as wider use of spirometry for diagnosis, are proposed [33,[38][39][40][41][89][90][91]. A study conducted at the beginning of the economic recession revealed major shortages in rural primary healthcare equipment; only 4.6% of rural doctors had spirometers available for clinical use [91].…”

Prevalence of Chronic Obstructive Pulmonary Disease in Patients With Coronary Heart Disease and Arterial Hypertension

“…It is argued by the data about the influence of broncholithus on heart rate, electrolytic changes. So, it is important to elaborate the simple available screening methods that allow to select patients for further functional examination with high reliability degree [11,[20][21][22]. This very aim is set in our work.…”