Using Targeted Spirometry to Reduce Non-Diagnosed Chronic Obstructive Pulmonary Disease

Abstract

Background: Chronic obstructive pulmonary disease (COPD) is increasing worldwide and thus its associated morbidity and mortality. However, COPD often goes undiagnosed. Objectives: We evaluated the rate of non-diagnosed irreversible airway obstruction (AO) and characterized this patient group. We further assessed the possible effects of conducting targeted spirometry in a population sample in Salzburg, Austria, as part of the Burden of Obstructive Lung Disease (BOLD) study. Methods: 1,258 adults ≧40 years of age completed a questionnaire and performed spirometry before and after bronchodilator therapy (post-BD). Irreversible AO was defined as post-BD FEV₁/FVC below the lower limit of normal; we used the FEV₁% predicted (pred.) to further grade the disease. Participants without a physician diagnosis of COPD who reported respiratory symptoms and a history of risk factors (ever smoking or occupational risk) were defined as eligible for targeted spirometry. Results: 85.9% (171/199) of the participants with irreversible AO did not report a prior diagnosis of COPD. Non-diagnosed AO was inversely related to severity, age, self-reported prior respiratory diseases and cough as a respiratory symptom. 343 participants were eligible for targeted spirometry and irreversible AO was present in 86 (25.1%) participants. Therefore, targeted spirometry could reduce the underdiagnosis of irreversible AO of any severity by 50.3% (86 of 171). The diagnosis of 1 person with FEV₁ <80% pred. would require spirometry in 8.4 subjects (95% confidence interval 6.2–11.1). Conclusion: Although several factors are associated with non-diagnosed AO, spirometry in individuals with respiratory symptoms and exposure to risk factors could reduce undiagnosed irreversible AO by half.

High-Resolution Computed Tomography Quantitation of Emphysema Is Correlated with Selected Lung Function Values in Stable COPD

“…Some authors have observed that very mild emphysema could be missed in in vivo measurements. This may explain why a substantial number of patients in our present study with considerable smoking history, probably suffering from very mild emphysema, did not show detectable emphysema on HRCT [32,33,34,35,36,37,38]. …”

Detection of Chronic Obstructive Pulmonary Disease in Primary Care in Salzburg, Austria: Findings from the Real World

“…This quality failure rate was much higher than that observed in the BOLD study, where only 3% of readings failed the same criteria [34]. For other studies on COPD detection in primary care, quality standards were not met in 8-40% of participants [23,24,25,35,36]. The current ATS/ERS quality criteria have been criticized as being too stringent for spirometry in primary care, and older, more disabled patients are often not able to perform a spirometry test of sufficient quality [16].…”

“…We assume, that participation rates will be greatly increased when patients are informed about the importance of spirometry tests and when participants are preselected for spirometry either because of respiratory symptoms or risk factors [24,25]. Such a targeted COPD detection strategy will also avoid oversampling of persons at low risk for COPD.…”

Accuracy and Precision of Desktop Spirometers in General Practices

“…Spirometry has become an essential tool for primary care doctors and nurses to diagnose and monitor chronic airways diseases [1,2,3,4]. In the Netherlands, spirometer ownership in general practices has increased substantially in the past decade (from 25% in 1998 to 62% in 2007) [5].…”