Kate Johnson

September 07, 2016

LONDON, United Kingdom — Primary care physicians play an important role in the identification of chronic obstructive pulmonary disease (COPD) and other respiratory conditions, although there is room for improvement, new research shows.

"Our results reveal that GPs, if informed and trained, can contribute to the screening of COPD at the primary care level," said lead investigator Isabella Annesi-Maesano, MD, PhD, DSc, from the French Institute of Health and Medical Research (INSERM) and Université Pierre et Marie Curie in Paris.

In fact, COPD diagnoses were confirmed in more than 70% of the patients referred to a chest specialist by a primary care physician in the Early Diagnosis of Obstructive Lung Disease (E-DIAL) study.

This was even true for a substantial number of patients who reported no symptoms, Dr Annesi-Maesano told Medscape Medical News.

She presented the findings during a late-breaking abstract session here at the European Respiratory Society (ERS) International Congress 2016.

E-DIAL Study

The study involved 6390 primary care patients in Italy. Mean age was 56.3 years.

After each patient completed a respiratory questionnaire and underwent a physical examination, the primary care physician decided whether to refer the patient to a chest specialist for further assessment.

Of the 701 patients referred to one of 22 participating pulmonary units, specialists agreed with the suspected diagnosis in 494 cases (70.5%). Among the diagnoses confirmed were COPD in 23.9% of cases, chronic bronchitis in 23.3%, asthma in 20.4%, rhinitis in 9.5%, and asthma plus rhinitis in 2.9%.

Of the 494 patients with confirmed diagnoses, 18% had reported respiratory complaints to their primary care physician but described themselves as healthy, Dr Annesi-Maesano reported.

This study "lends weight to the evidence that case finding using a respiratory screening questionnaire is a reasonable approach in primary care and facilitates the identification of new cases of COPD, " Rachel Jordan, PhD, from the University of Birmingham in the United Kingdom, told Medscape Medical News.

However, in the recent TargetCOPD trial, Dr Jordan and her colleagues found that routine screening by primary care physicians is inferior to a targeted approach for identifying COPD (Lancet Respir Med. 2016;4:720-730).

But "the key question in the identification of undiagnosed COPD is whether it is actually beneficial to the patient in the long term," she pointed out.

This is a fair question; there are currently no COPD treatments that tackle the underlying disease process, said Peter Barnes, DM, head of respiratory medicine at Imperial College London, United Kingdom, and chair of the ERS.

"Existing treatments are mainly bronchodilators, which just address symptoms, but if we can get patients to stop smoking, they stop getting worse. And the earlier people stop smoking, the greater the benefit," he said.

Dr Annesi-Maesano, Dr Jordan, and Dr Barnes have disclosed no relevant financial relationships.

European Respiratory Society (ERS) International Congress 2016: Abstract PA 1155. Presented September 4, 2016.


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