LATE-BREAKING ABSTRACT: Early DIAgnosis of obstructive Lung disease at primary care level. The E-DIAL study

Abstract

Background : In Italy, Chronic Obstructive Pulmonary Disease (COPD) is poorly diagnosed. E.DIAL study tested the capability of General Practitioners (GP) to suspect it. Population and methods : In each primary care practice a random sample of 20 patients was enrolled and filled the WHO standardized respiratory questionnaire. After evaluation and visit, GP filled a form and if suspected COPD, referred pts to Pulmonary Unit (PU) for a chest physician (CP) visit and pulmonary function tests (PFT). 22 PUs joined, each one contacting a mean of 10 GPs. Results: D ata were available of 6390 pts. (mean age 56.3 y. women= 53%). 8.7% reported chronic cough, 6.6% chronic phlegm, 17.9% wheezing in the past year, 7.8% wheezing in the absence of a cold, 5.8% breathlessness on walking, 4.1% a diagnosis of emphysema and 9.8% of asthma. Out of 6390, 897 pts reported at least 1 respiratory symptom but no diagnosis. 701 of them (78.1%) (mean age 63.0 y) were referred to PU as suspected of COPD. Among them, 494 patients (70.5%) got a confirmed diagnosis of respiratory diseases (COPD=23,9%; asthma= 20,4%; Chronic bronchitis=23,3%; rhinitis= 9,5%; asthma + rhinitis=6,9%). Among the 701 referred pts, 123 (18%) not diagnosed of a respiratory condition showed obstruction at PFT. Conclusions: In our sample, concordance between the CP and the GP9s diagnosis was 70.5%. But 21.9% (196/897) symptomatic pts were not referred to PU. 18% of obstructed pts were unaware of their condition. Early diagnosis of COPD by GP seems feasible but perfectible. Further patients9 and GP9 education on respiratory diseases and symptoms seems necessary. Bibliography: Protocol for Assessment of Burden of Major Respiratory Diseases at the PHC Level.