Improved prediction of COPD in at-risk patients using lung function pre-screening in primary care: a real-life study and cost-effectiveness analysis

Abstract

Background: The importance of identifying chronic obstructive pulmonary disease (COPD) at an early stage is recognised. Improved and easily accessible identification of individuals at risk of COPD in primary care is needed to select patients for spirometry more accurately.

Spirometry: an essential tool for screening, case-finding, and diagnosis of COPD

“…In other words, maximising the chances of positively identifying COPD means that more patients would have to be referred for confirmatory diagnostic spirometry, arguably unnecessarily. All three microspirometry studies 6,9,10 demonstrate a high negative predictive value -i.e. they predict with at least 90% accuracy that the patient does not have COPD.…”

“…Thorn and colleagues 6 report that a pre-bronchodilator FEV1/FEV6 ratio <0.73, measured using the hand-held copd-6, could be used as a case-finding test prior to referral for diagnostic spirometry in order to confirm or refute a diagnosis of COPD. Using diagnostic postbronchodilator spirometry, they then demonstrated a COPD prevalence of 25.2% in a patient population of 305 current and exsmokers (at least 15 pack years) aged 45 to 85 years who had been identified from 21 urban and rural primary health centres in Sweden.…”

“…Conducting post-bronchodilator casefinding would also increase the training required, the need for clinical supervision, and the cost. 6 This would potentially reduce the utility of the test. Indeed, since the UK National Institute of Health and Clinical Excellence (NICE) guideline for COPD 13 advocates opportunistic case-finding conducted in 'at risk' populations, the case-finding test would need to be available for use at general practice facilities, smoking cessations clinics or local pharmacies.…”

“…5 Primary care providers have the major responsibility for managing this condition, and thus it is appropriate to study acute rhinosinusitis in a primary care setting. In this issue of the Primary Care Respiratory Journal, Stjärne and colleagues 6 report on the high costs and health-related QoL in acute rhinosinusitis in a Swedish primary care setting. Using a prospective, observational study design at 11 sites, QoL and cost analyses in adults with acute rhinosinusitis were assessed.…”

“…In the first paper, Thorn and colleagues report on the copd-6 -a simple hand-held microspirometer device (Vitalograph, Ireland) that measures FEV 1/FEV6 -and its usefulness and cost-effectiveness in providing pre-standard spirometry for COPD case-finding. 6 In the second, Abramson et al report a mixed methods study on the accuracy of asthma and COPD diagnosis in Australian primary care. 7 There are considered perspectives available from both proponents and opponents to the concept of COPD case-finding in primary care -as previously debated and then summarised recently in this journal.…”