Early detection of COPD in general practice

Abstract

Charlotte Suppli Ulrik1, Anders Løkke2, Ronald Dahl3, Jens Dollerup4, Gert Hansen4, Patrick Hagge Cording5, Klaus Kaae Andersen5, On behalf of the TOP study group 1Department of Heart and Lung Diseases, Hvidovre University Hospital, Hvidovre; 2Department of Internal Medicine, Silkeborg Hospital, Silkeborg; 3Department of Respiratory Diseases, Århus University Hospital, Århus; 4Pfizer Aps, Ballerup; 5Informatics, Section for Statistics, Technical University of Denmark, Lyngby, DenmarkBackground and aim: Early detection enables the possibility for interventions to reduce the future burden of COPD. The Danish National Board of Health recommends that individuals >35 years with tobacco/occupational exposure, and at least 1 respiratory symptom should be offered a spirometry to facilitate early detection of COPD. The aim, therefore, was to provide evidence for the feasibility and impact of doing spirometry in this target population.Methods: Participating general practitioners (GPs) (n = 335; 10% of the Danish GPs) recruited consecutively, subjects with >35 years exposure, no previous diagnosis of obstructive lung disease, and at least 1 of the following symptoms: cough, dyspnea, wheezing, sputum, or recurrent respiratory infection. Data on age, smoking status, pack-years, body mass index (BMI), dyspnea score (Medical Research Council, MRC), and pre-bronchodilator spirometry (FEV1, FEV1% predicted, FEV1/FVC) were obtained.Results: A total of 3.095 (51% females) subjects was included: mean age 58 years, BMI 26.3, and 31.5 pack-years. The majority of subjects (88%) reported MRC score 1 or 2. FEV1/FVC-ratio ≤ 0.7 was found in 34.8% of the subjects; the prevalence of airway obstruction increased with age and decreased with increasing BMI, and was higher in men and current smokers. According to the level of FEV1, 79% of the subjects with airway obstruction had mild to moderate COPD.Conclusions: More than one-third of the recruited subjects had airway obstruction (FEV1/ FVC < 0.7). Early detection of COPD appears to be feasible through offering spirometry to adults with tobacco/occupational exposure and at least 1 respiratory symptom.Keywords: COPD, spirometry, general practice, airway obstruction, screening