Risk stratification for COPD diagnosis through an active search strategy in primary care

Abstract

Background

The aim of this study was to identify the percentage of undiagnosed patients with COPD through the implementation of an active search strategy in a selected subject population.

Methods

An observational, cross-sectional, multicenter study was conducted in a primary care setting in Spain. General practitioners gave their diagnostic impression of COPD (yes/no) on the basis of clinical criteria of subjects with respiratory symptoms and tobacco exposure. Subsequently, post-bronchodilator spirometry and quality-of-life tests were performed. Multivariate logistic regression techniques using receiver operating characteristic (ROC) curves were used to identify the combination of variables that best discriminates COPD.

Results

A total of 2,758 patients were screened at 368 primary care centers, of which 1,725 patients were included in the study. Seven hundred and ninety-three patients (46%) were diagnosed with COPD. Clinical judgment resulted in suspected COPD in 1,393 (81%) of the subjects. The best variables to discriminate COPD were a history of lower respiratory tract infections, cough, and dyspnea. This combination identified COPD with a ROC_AUC of 0.61 denoting a poor discriminative ability.

Conclusion

Employing an active search strategy leads to a new COPD diagnosis in almost half of the subjects. Screening of COPD with post-bronchodilator spirometry should be considered mandatory for any high-risk subject visiting the general practitioner clinic for any reason.

Keywords:

• COPD
• post-bronchodilator spirometry
• primary care
• screening

Acknowledgments

The authors would like to thank all the primary care physicians who participated in the study. The authors also wish to thank Eva Mateu from TFS who provided medical writing services on behalf of Novartis Farmacéutica SA, Barcelona, Spain. Financial support for the study was provided by Novartis Farmacéutica SA, Barcelona, Spain.

Author contributions

PJM, RMM, and RC designed and supervised the overall study. PJM, RMM, and RC participated in the writing of the manuscript, provided important intellectual content, and gave their final approval of the version submitted for publication. All authors contributed toward data analysis, drafting and critically revising the paper and agree to be accountable for all aspects of the work.

Disclosure

PJM and RMM declare that they have no competing interests. RC is an employee of Novartis. The authors report no other conflicts of interest in this work.