Jill Taylor

October 18, 2004

Oct. 18, 2004 (Orlando) — Chronic obstructive pulmonary disease (COPD) appears to be underdiagnosed in primary care, especially in patients who are young and in preclinical stages, according to a new study. Early detection can be improved with the use of office spirometry, the researchers said.

The research, presented here at the 17th World Conference of Family Doctors by Jan Kartounian, MD, professor of general practice at the University of Brussels in Belgium, was performed to evaluate the role of office spirometry in the early detection of COPD in patients aged 40 to 70 years with a history of smoking 15 or more packs a year.

The population was identified from 2,926 patients who contacted general practitioners in three semi-rural general practices during a two-month study period. Of these, 122 subjects met the inclusion criteria, 104 of whom were willing and able to adequately perform spirometry. A total of 15 patients in this population had been previously diagnosed with COPD.

A questionnaire was completed to obtain information on smoking habits, respiratory symptoms, and history of pulmonary disease. In the 89 subjects not previously diagnosed with COPD, spirometry was performed using a handheld spirometer.

GOLD guidelines were used for the diagnosis of COPD and assessment of severity. "Small airways disease" was diagnosed if MEF25-75 was smaller than 65% of the predicted value. To distinguish COPD from asthma, reversibility was tested by repeat spirometry performed 15 minutes after inhalation of 240 µg of salbutamol in combination with 40 µg of ipatropium. An additional four patients were excluded from the study due to the discovery of asthma.

Overall, abnormal spirometry was detected in 67% of the entire study population. Of the 89 patients with no previous diagnosis of COPD, office spirometry results indicated 63% with stage I COPD (mild), 33% with stage II (moderate), 4% with stage III (severe), and none with stage IV (very severe). In addition, 41% of these subjects showed spirometric signs of small airways disease.

Notably, the presence of respiratory symptoms did not differ significantly between subjects with or without COPD, except for wheezing (P = .01) and abnormal lung auscultation (P = .001).

Marshall Godwin, MD, MSc, CCFP, FCFP, professor and director of the Centre for Studies in Primary Care at Queen's University in Kingston, Ontario, noted that COPD treatments are really symptom-based. "So this information may not change the course of the illness unless you can use it to convince patients to take action," he told Medscape. Dr. Godwin was not involved with the study.

According to Dr. Kartounian, this observation addresses the next step in the investigation. The researchers plan to evaluate whether patients who are presented with spirometry results indicating early disease can be persuaded to quit smoking. "There is research that just came out which looked at this very issue," he told Medscape. "Unfortunately, those results showed that smokers declined to quit."

Dr. Kartounian did not report outside sources of study funding or conflicts of interest.

17th World Conference of Family Doctors: Abstract 3740. Presented Oct. 15, 2004.

Reviewed by Gary D. Vogin, MD



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