Abstract
Background. Chronic Obstructive Pulmonary Disease (COPD) is underdiagnosed in primary care. Aim. To explore the utility of proactive identification of COPD in patients 75 years of age and older in a Canadian primary care setting. Methods. Canadian Thoracic Society (CTS) screening questions were administered to patients with a smoking history of 20 pack-years or more; those with a positive screen were referred for postbronchodilator spirometry. Results. A total of 107 patients (21%), of 499 screened, had a 20-pack-year smoking history; 105 patients completed the CTS screening. Forty-four (42%) patients were positive on one or more questions on the screening; significantly more patients with a previous diagnosis of COPD (64%) were positive on the CTS compared to those without a previous diagnosis of COPD (30%). Of those who were not previously diagnosed with COPD (N = 11), four (36%) were newly diagnosed with COPD. Conclusion. A systematic two-stage method of screening for COPD, using CTS screening questions followed by spirometric confirmation, is feasible in the context of a busy primary care setting. More research is needed to assess the value of restricting screening to patients with a smoking history of 20 pack-years and on the sensitivity and specificity of these measures.
Highlights
Chronic Obstructive Pulmonary Disease (COPD) is associated with increasing economic and social burden and is a leading cause of morbidity and mortality worldwide [1]
Over half had a history of hypertension; 11% had a previous diagnosis of COPD
This study explored the use of opportunistic case identification of older adults with COPD in a Canadian primary care setting, using systematic inquiry to identify symptoms suggesting individuals at highest risk who might benefit from diagnostic spirometry
Summary
Chronic Obstructive Pulmonary Disease (COPD) is associated with increasing economic and social burden and is a leading cause of morbidity and mortality worldwide [1]. A national surveillance study found that prevalence rates increased with age, increasing from 3.3% in those 50–59 years of age to 6.6% and 11.3%, respectively, in those 60–69 and 70–79 years of age [3] This trend is evident globally, with prevalence estimates of COPD increasing with age from 2.7% in those under 40 years of age to 7.6% among 40–64 year olds and 15% among those aged 65 years and older [5]. Aim. To explore the utility of proactive identification of COPD in patients 75 years of age and older in a Canadian primary care setting. A systematic two-stage method of screening for COPD, using CTS screening questions followed by spirometric confirmation, is feasible in the context of a busy primary care setting. More research is needed to assess the value of restricting screening to patients with a smoking history of 20 pack-years and on the sensitivity and specificity of these measures
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