Vision at risk

October 2009

Research

Feasibility and efficacy of COPD case finding by practice nurses

Volume 38, No.10, October 2009 Pages 826-830

Jeremy Bunker

Oshana Hermiz

Nicholas A Zwar

Sarah M Dennis

Sanjyot Vagholkar

Alan J Crockett

Guy Marks

Background

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.

Methods

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.

Results

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.

Discussion

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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Correspondence afp@racgp.org.au

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