Novel Approach May Help Primary Care Clinicians Better Diagnose COPD

With the help of 5 simple questions and a peak expiratory flow (PEF) device, primary care clinicians may be able to diagnose more individuals with chronic obstructive pulmonary disease (COPD).

In a study published in the American Journal of Respiratory and Critical Care Medicine, researchers developed a novel method to identify patients with COPD with severity significant enough to justify therapy with available agents. The approach is intended for the use in a primary care setting.

“The researchers created and tested a simple tool that could help practitioners improve care by finding people who have COPD but didn’t know it,” said Dr James Kiley, director of the Division of Lung Diseases at the National Heart, Lung, and Blood Institute. “The hope is that by finding individuals with COPD at an earlier stage of illness, we might be able to offer them treatments which can improve their disease.”

This approach begins with patients completing a COPD Assessment in Primary Care to Identify Undiagnosed Respiratory Disease and Exacerbation Risk (CAPTURETM). There are 5 questions written at a 6 grade level that assess breathing problems, smoke and pollution exposure, how easily they tire, and the number of acute respiratory illnesses.

Respondents who had answers indicative of being at high risk for COPD symptoms and/or exacerbations were referred directly to definitive diagnostic testing, while those with answers that fell in the middle range for risk performed a PEF test during their visit. Patients whose answers indicated minimal risk symptoms and exacerbations require no further testing.

For the PEF test, men who exhale less than 350 liters/minute and women who exhale less than 250 liters/minute are referred for definitive testing.

In the case-control study, researchers enrolled 346 men and women with an average age of 63-years-old. The results of the study found that 52% of participants required PEF to determine if further diagnostic testing was required.

The questionnaire combined with the PEF showed a high rate of sensitivity (89.7%) and specificity (78.1%) for cases versus controls, which included those with mild COPD, according to the study. When compared with non-COPD controls, the sensitivity was similar but the specificity increase to 93.1%.

Researchers noted that the success of their study was a result of the input from patients and primary care collaborators from the beginning of the development process.

“Primary care clinicians were emphatic: it could not be a long and complicated questionnaire, and we could not include complex pulmonary function testing upfront,” said lead study author Fernando J. Martinez, MD, MS.

Initially, researchers started with 44 possible questions, but with the help of patients, they were able to choose the 5 best questions and also provided key insights into the wording.

“We as clinicians did not expect some of the questions to be included but they resonated with patients,” Martinez said.

The 5 final questions were as followed:

• Does your breathing change with seasons, weather, or air quality?
• Compared to others your age, do you tire easily?
• Have you ever lived or worked in a place with dirty or polluted air, smoke, second-hand smoke or dust?
• In the past 12 months, how many times did you miss work, school, or other activities due to a a cold, bronchitis, or pneumonia?
• Does your breathing make it difficult to do things such as carry heavy loads, shovel dirt or snow, jog, play tennis or swim?