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Chronic Obstructive Pulmonary Disease
Chronic Obstructive Pulmonary Disease –
Is It Time for Spirometry Screening?
Georgios Stratelis
1
and Jörgen Thorn
2
1. Director of Respiratory Medicine, AstraZeneca Sweden; 2. Associate Professor, Sahlgrenska School of Public Health and Community Medicine,
Section of Primary Healthcare, University of Gothenburg
Abstract
Early detection of chronic obstructive pulmonary disease (COPD) and secondary prevention by means of smoking cessation are the only
available methods of stopping the progression of the disease. There is scope for being more proactive for early detection and prevention
of COPD in general practice. The specific issues addressed in this article are underdiagnosis of COPD, delays by patients and doctors
regarding early diagnosis and targeted, selective screening for COPD. In addition, we discuss the effect of spirometry on smoking cessation.
The purpose of this article is to show the benefits of working more proactively towards early detection of the disease.
Keywords
Chronic obstructive pulmonary disease (COPD), spirometry, screening, smoking cessation
Disclosure: The authors have no conflicts of interest to declare.
Received: 5 November 2008 Accepted: 14 May 2009
Georgios.Stratelis@astrazeneca.com
Chronic obstructive pulmonary disease (COPD) is a major public degree of patient delay. The discrepancy between lung function and
health problem. Cigarette smoking is the main cause of COPD. The subjective health resulting in an adaptation is schematically
prevalence of COPD is still increasing worldwide, as is the mortality illustrated in Figure 1.
rate.
1–4
The importance of identifying smokers with COPD at an early
stage and supporting smoking cessation is unquestionable, and is The concept of patient and doctor delay was considered in the
recognised in several national and international guidelines.
1,5,6
An epidemiological study by Lindberg et al.
16
Although all COPD-diagnosed
important role of physicians in primary care is early detection of subjects (>45 years of age) reported respiratory symptoms, only about
COPD and motivating smokers to stop smoking, as smoking cessation 50% had consulted the healthcare system (patient delay) and a minority
is the only intervention that has been proved to prevent further of those (16%) were diagnosed as having COPD (doctor delay). The
decline in lung function.
7–9
Since smoking has a wide range of serious reasons for doctor delay are multifactorial. General practitioners (GPs)
effects on health, even a small improvement in cessation rates has are busy with other groups such as those with hypertension, heart
been considered clinically important.
10
The purpose of this article is to diseases, diabetes, respiratory infections, psychiatric disorders and
show the benefits of working in a more proactive way for the early orthopaedic diseases. Other important factors may be a lack of time and
detection of the disease. spirometry equipment and/or education in primary care. In most
countries, primary care clinicians treat the vast majority of patients with
Patient or Doctor Delay chronic respiratory diseases, as exemplified by the UK and The
COPD still remains relatively unknown or ignored by the public as Netherlands, where approximately 85% of patients with asthma and
well as by public health officials, resulting in either underdiagnosis COPD are managed almost entirely by GPs and primary care nurses.
17
or delayed diagnosis of COPD.
11–13
Thus, in principle the Access to spirometry is increasing in primary care. In Sweden about 90%
underdiagnosis of COPD is theoretically caused by delays by the of primary healthcare centres (PHCCs) have access to spirometry.
18
patient or the doctor. The main causes of patient delay are low However, it is reported that primary care physicians seldom use
knowledge of the disease and adaptation to the disease. Data from spirometry to discover COPD among smokers or people with respiratory
the Third National Health and Nutrition Examination Survey symptoms.
19
A report from the National Lung Health Education Program
(NHANES III) showed that a significant proportion of patients with in the US recommends that smokers >45 years of age and actively
severe COPD (forced expiratory volume in one second [FEV
1
] <50% smoking should be examined by spirometry regardless of their cause for
of predicted) may not report symptoms. The symptoms reported seeking medical attendance or presence of symptoms.
20
most frequently were wheezing and shortness of breath, in 64 and
65% of subjects, respectively.
14
On the other hand, knowledge of the Should We Screen Smokers for
disease (or any labelling synonymous with COPD, i.e. emphysema, COPD with Spirometry?
smoker’s lung) was acknowledged by only 39% of subjects.
15
In With all of this in mind, should we screen smokers for COPD? The
combination with the inherent adaptation to the symptoms of the definition of screening according to the UK national screening
disease, this low level of awareness results in a considerable committee is “when members of a defined population who do not
© TOUCH BRIEFINGS 2009 29
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