Nicholas A Zwar
Sarah M Dennis
Alan J Crockett
Chronic obstructive pulmonary disease (COPD) is a leading cause
of disability, hospital admission and premature mortality, but is often
undiagnosed. This study assessed the effectiveness, feasibility and
acceptability of COPD case finding by practice nurses performing
spirometry on patients identified as being at risk of developing COPD.
Practice nurses were trained in spirometry. From four general
practices, 1010 patients were identified who were aged 40–80 years
and current or ex-smokers. Four hundred were randomised to receive
a written invitation to attend a case finding appointment with the
practice nurse, including spirometry.
Seventy-nine patients attended, 16 (20.3% of attendees) had COPD
diagnosed on spirometry; practice nurses correctly identified 10 of
the 16, but also incorrectly identified a further six patients as having
COPD. One patient in the usual care group was diagnosed with COPD,
but this was not confirmed on spirometry.
This study confirmed that COPD is underdiagnosed, with 20% of those
at risk and attending for screening having COPD. The search strategy
successfully identified patients at risk. Further training in spirometry
would be required for practice nurses to increase the accuracy of
the diagnoses. The opportunity cost would require consideration.
The acceptability to patients is also an issue, this may be related
to the recruitment method or the intervention. This study also does
not answer whether earlier diagnosis in these patients leads to any
change in outcomes.
Chronic obstructive pulmonary disease (COPD) is a leading cause of disability, hospital admission and premature mortality.1 Nationwide, the costs of COPD are estimated to be $820–900 million annually.2 Its prevalence is estimated to be 3.5% of the Australian population, however the true prevalence is likely to be greater as COPD is often undiagnosed.3 It is estimated that 15–20% of smokers will develop clinically significant COPD,4,5 although more recent research suggests that this may be as much as 50%.6
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