Underdiagnosis of Chronic Obstructive Pulmonary Disease: A Rationale for Spirometry as a Screening Tool

McIvor, R Andrew; Tashkin, Donald P.

doi:10.1155/2001/941219

Cited by 23 publications

(14 citation statements)

References 31 publications

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“…Other studies have suggested that adults seeking treatment at PHCCs and presenting with risk factors for COPD and typical respiratory symptoms should be priority targets for screening and early intervention. (18)(19)(20) In the present study, the COPD patients with a previous diagnosis of COPD had a higher degree of obstruction, as evidenced by the FEV 1 values in percentage of predicted. This might have been due to the fact that respiratory symptoms were more common in that subgroup.…”

Section: Resultssupporting

confidence: 47%

Subdiagnóstico de DPOC na atenção primária em Aparecida de Goiânia, Goiás

2012

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Objective: To estimate the prevalence of undiagnosed COPD among individuals with risk factors for the disease treated at primary health care clinics (PHCCs) in the city of Aparecida de Goiânia, Brazil. Methods: Inclusion criteria were being ≥ 40 years of age, having a > 20 pack-year history of smoking or a > 80 hour-year history of exposure to biomass smoke, and seeking medical attention at one of the selected PHCCs. All subjects included in the study underwent spirometry for the diagnosis of COPD. Results: We successfully evaluated 200 individuals, mostly males. The mean age was 65.9 ± 10.5 years. The diagnosis of COPD was confirmed in 63 individuals, only 18 of whom had been previously diagnosed with COPD (underdiagnosis rate, 71.4%). There were no significant differences between the subgroups with and without a previous diagnosis of COPD in relation to demographics and risk factors. However, there were significant differences between these subgroups for the presence of expectoration, wheezing, and dyspnea (p = 0.047; p = 0.005; and p = 0.047, respectively). The FEV 1 and FEV 1 /FVC ratio, expressed as percentages of the predicted values, were significantly lower in the subjects with a previous diagnosis of COPD, which was predominantly mild or moderate in both subgroups. Conclusions:The rate of underdiagnosis of COPD was high at the PHCCs studied. One third of the patients with risk factors for COPD met the clinical and functional criteria for the disease. It seems that spirometry is underutilized at such facilities.Keywords: Pulmonary disease, chronic obstructive/diagnosis; Primary health care; Spirometry. ResumoObjetivo: Estimar a prevalência de DPOC não diagnosticada entre indivíduos com fatores de risco para a doença atendidos em unidades básicas de saúde (UBS) na cidade de Aparecida de Goiânia (GO). Métodos: Os critérios de inclusão foram ter idade ≥ 40 anos, ter história de tabagismo > 20 maços-ano ou de exposição à queima de biomassa > 80 horas-ano e procurar atendimento médico em uma das UBS selecionadas. Todos os indivíduos incluídos no estudo foram submetidos a espirometria para a definição diagnóstica de DPOC. Resultados: Foram avaliados com sucesso 200 indivíduos, a maioria do sexo masculino. A média de idade foi de 65,9 ± 10,5 anos. Tiveram confirmação diagnóstica de DPOC 63 indivíduos. Desses, apenas 18 haviam sido previamente diagnosticados com DPOC (taxa de subdiagnóstico de 71,4%). Não houve diferenças significantes entre os subgrupos com e sem diagnóstico prévio de DPOC em relação a fatores demográficos e fatores de risco. Entretanto, houve diferenças significantes entre esses subgrupos em relação à presença de expectoração, chiado e dispneia (p = 0,047, p = 0,005 e p = 0,047, respectivamente). Os valores de VEF 1 e VEF 1 /CVF, em percentual do previsto, foram significativamente menores nos indivíduos com diagnóstico prévio de DPOC. A DPOC foi predominantemente leve a moderada em ambos os subgrupos. Conclusões: A taxa de subdiagnóstico da DPOC foi alta nas UBS estudadas. Um terço dos...

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Section: Resultssupporting

confidence: 47%

Subdiagnóstico de DPOC na atenção primária em Aparecida de Goiânia, Goiás

2012

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“…This lack of awareness is concerning, in view of the large health burden that COPD presents to patients and society. 3,4,6,[15][16][17][18] Measures of lung function are also key elements in stratifying patients into different treatment strategies, for both COPD 6 and asthma. 19 Moreover, early COPD detection and smoking-cessation are essential to controlling disease progression.…”

Section: Discussionmentioning

confidence: 99%

“…2 Spirometry can adequately screen high-risk individuals for silent airflow limitation, 3,15,16,18,20 -22 and numerous studies have now identified airflow limitation as strongly associated with general health status. 12,13,17 Yet public awareness and physician appreciation of this subject appears to pale in comparison to more familiar diseases such as heart disease, stroke, and cancer.…”

Section: Discussionmentioning

confidence: 99%

Knowledge and use of office spirometry for the detection of chronic obstructive pulmonary disease by primary care physicians

Kaminsky

Marcy

Bachand

et al. 2006

Respiratory Medicine: COPD Update

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BACKGROUND: The importance of office spirometry has been strongly advocated in the pulmonary community, but whether its importance is recognized and accepted by primary care physicians is less well established. METHODS: To assess primary care physicians' knowledge and use of office spirometry for the detection of chronic obstructive pulmonary disease, we conducted a brief mail survey on the local practice of office spirometry, barriers to performing office spirometry, and general knowledge about spirometry. We also provided 60-min educational workshops to assess whether such an approach would increase spirometry testing or perceptions about spirometry. RESULTS: Twenty-nine of 57 (51%) primary care offices responded to the survey. Of these, 66% owned their own spirometer. The most common reasons for not performing spirometry were uncertainty about the impact of the test (41%), physician and staff unfamiliarity (38%), and lack of training (34%). Twenty-one respondents participated in the workshops. In the 3 months following the workshops, the number of spirometry tests increased by 59% (p ‫؍‬ 0.004). After the workshops, the proportion of clinics that reported reasons for not performing the test decreased by 13% (p ‫؍‬ 0.01), but important barriers to performing office spirometry were still present, including physician and staff unfamiliarity (22%), uncertain interpretation of results (22%), time (22%), and reimbursement (22%). CONCLUSIONS: The general knowledge and use of office spirometry in the primary care community is poor, but can be improved, at least in the short-term, by a simple educational workshop.

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“…Screening of asymptomatic individuals has been criticized, leading to recent guidelines recommending against population screening for COPD (26,27). There is, however, evidence to suggest that targeted screening strategies may be useful (28)(29)(30)(31). The Canadian Thoracic Society guidelines, therefore, recommend targeted screening of patients at risk for COPD (16).…”

Section: Discussionmentioning

confidence: 99%

Implementation of a Targeted Screening Program to Detect Airflow Obstruction Suggestive of Chronic Obstructive Pulmonary Disease within a Presurgical Screening Clinic

Robitaille

Dajczman

Hirsch

et al. 2015

Canadian Respiratory Journal

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C hronic obstructive pulmonary disease (COPD) is highly prevalent, affecting 9% to 26% of individuals ≥40 years of age, and is the fourth leading cause of death in Canada (1-4). More than 750,000 Canadian adults report being diagnosed with COPD by a health care professional (5). COPD appears to be underdiagnosed because prevalence rates based on spirometry testing are two to six times higher than estimates based on patients' self-reports of a physician diagnosis (6,7).Early diagnosis and management of COPD is important because it is a leading cause of hospitalization and emergency department visits (8)(9)(10)(11)(12). Early detection enables the initiation of treatment, if needed, and for secondary preventive strategies including smoking cessation, education and healthy lifestyle changes (13-15). The Canadian Thoracic Society recommends spirometry testing for individuals at risk for COPD: individuals >40 years of age with a past or present smoking history and at least one respiratory symptom, such as breathlessness, wheezing, cough, or persistent phlegm and frequent lung infections (16). Despite the simplicity of spirometry, limitations regarding access, use, quality and interpretation of results are considerable (17)(18)(19).A novel targeted screening program was implemented within the presurgical screening (PSS) clinic of a tertiary care hospital. This was initiated in response to indications that avoidable postoperative pulmonary complications were occurring in patients with previously undiagnosed COPD and in COPD patients with poorly controlled disease. A quality assurance study was performed to evaluate the detection rate of airflow obstruction and to examine the characteristics of individuals identified through the targeted screening program. BACKGROUND: Targeted spirometry screening for chronic obstructive pulmonary disease (COPD) has been studied in primary care and community settings. Limitations regarding availability and quality of testing remain. A targeted spirometry screening program was implemented within a presurgical screening (PSS) clinic to detect undiagnosed airways disease and identify patients with COPD/asthma in need of treatment optimization. OBJECTIVE: The present quality assurance study evaluated airflow obstruction detection rates and examined characteristics of patients identified through the targeted screening program. METHODS:The targeted spirometry screening program was implemented within the PSS clinic of a tertiary care university hospital. Current or ex-smokers with respiratory symptoms and patients with a history of COPD or asthma underwent prebronchodilator spirometry. History of airways disease and smoking status were obtained during the PSS assessment and confirmed through chart reviews. RESULTS: After exclusions, the study sample included 449 current or ex-smokers. Abnormal spirometry results were found in 184 (41%) patients: 73 (16%) had mild, 93 (21%) had moderate and 18 (4%) had severe or very severe airflow obstruction. One hundred eighteen (26%) new cases of airflow ob...

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Underdiagnosis of Chronic Obstructive Pulmonary Disease: A Rationale for Spirometry as a Screening Tool

Cited by 23 publications

References 31 publications

Subdiagnóstico de DPOC na atenção primária em Aparecida de Goiânia, Goiás

Subdiagnóstico de DPOC na atenção primária em Aparecida de Goiânia, Goiás

Knowledge and use of office spirometry for the detection of chronic obstructive pulmonary disease by primary care physicians

Implementation of a Targeted Screening Program to Detect Airflow Obstruction Suggestive of Chronic Obstructive Pulmonary Disease within a Presurgical Screening Clinic

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