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Chronic Obstructive Pulmonary Disease
Table 1: COPD Prevalence in Different Surveys Using Invitational, Targeted Screening of COPD
Zielinski et al. Van Schayck et al. Geijer et al. Stratelis et al. Vandervoorde et al.
(Poland) (Netherlands) (Netherlands) (Sweden) (Belgium)
N 11,000 169 702 512 146
Method used Local media Invitation at Invitation by letter Local media (newspaper Invitation at
(radio and TV) visit to PCC and placards at PCC) visit to PCC
Age limits (years) 40–89 35–70 40–65 40–55 40–70
Screened Smokers and Smokers Smokers (male) Smokers Smokers and
population ex-smokers pack-years >15
Mean age 52 47 50 48 52
Definition of GOLD BTS/NICE GOLD ERS GOLD
COPD FEV% <70% FEV% <70% and FEV% <70% FEV% pred. <88 (male) FEV% <70%
FEV
1
<80% pred. FEV% pred. <89 (female)
Prevalence of COPD (%) 30.6 18 29.9 27 29.5
Different criteria used for definition of chronic obstructive pulmonary disease (COPD).
GOLD = Global Initiative for Chronic Obstructive Lung Disease; BTS = British Thorasic Society; NICE = National Institute for Health and Clinical Excellence; ERS = European Respiratory Society;
PCC = primary care centre.
Figure 1: The Discrepancy Between Objective and 70 years of age from the general population, no significant difference
Subjective Experience of Disease Severity
in healthcare resource utilisation and cost between the screened
subjects and controls was observed during a 3.6-year follow-up. The
Discrepancy Adaptation
Subjective health
authors concluded that there were no indications that screening for
100
Decline in FEV
1 obstructive airway disease led to increased cost above that of
80
Optimal diagnosis of COPD
average care.
27
60
Diagnosis of COPD today Critics against screening claim that spirometry tests carried out in
40 primary healthcare do not keep the same standards as spirometry
carried out at departments of physiology or by a trained nurse at
20
hospital clinics. The consequences would be unacceptable tests or a
0
risk of misclassification of smokers, declaring smokers with COPD as
25 50 75
healthy and vice versa. However, a study by Vandevoorde showed
Age (years)
that only 5.6% of spirometry tests performed in general practices
Chronic obstructive pulmonary disease (COPD) patients gradually adapt themselves to their
symptoms, which leads to a patient delay in not seeking medical care in time.
were unacceptable.
28
Moreover, Schermer et al. found that the quality
of spirometric tests in laboratories and general practices in terms of
necessarily perceive that they are at risk of, or are already affected by, test reproducibility seemed equivalent.
29
Screening means a
a disease or its complications are offered a test to identify those systematic approach at different levels and in different ways
individuals who are more likely to be helped than harmed by further depending on what you aim to screen for. This systematic approach
tests or treatment to reduce the risk of disease or its complications”.
21
can be performed at various levels, i.e. national, regional, local or
Screening for COPD fulfils all World Health Organization (WHO) criteria personal (doctor’s) level. With the screening definition in mind,
for a disease that is suitable for screening:
22
‘targeted, selective screening’ of a high-risk population should not be
controversial. In fact, there is now evidence that targeted, selective
• COPD constitutes an important health problem; screening is successful (in both regional and local screening
• the natural history of the disease is well understood; programmes) in terms of identifying smokers with COPD at an early
• a suitable and an accepted screening test is available (spirometry); stage (see Table 1).
15,28,30–33
All of these studies using targeted, selective
• it is possibile to diagnose the condition in a latent or early phase; screening used an invitational method to attract smokers. The
• treatment (smoking cessation) at an early stage is of more benefit examined populations were invited by letter, local media (TV, radio
than at a later stage; and broadcasts and newspapers), posters at the PHCC and pharmacy or,
• it represents reasonable costs in relation to other needs in public during a specific period of time, GPs invited all smokers attending
medical service. their surgery. Price and colleagues showed that a simple patient self-
administered questionnaire can be used to identify smokers with a
A clinical diagnosis of COPD is often made when patients have rather high likelihood of having COPD, for whom spirometric testing is
advanced disease, resulting in considerable functional impairment. If particularly important. This kind of questionnaire could enhance the
spirometry were used more often, COPD could easily be detected in efficiency and diagnostic accuracy of current screening efforts.
34
the early pre-clinical phase when smoking cessation advice would
have the best chance of preventing progression to severe, disabling Spirometry Screening for COPD and the
disease.
23,24
Furthermore, Walker et al. found that primary care Impact on Smoking Cessation
spirometry not only increases rates of COPD diagnosis, but also leads Spirometry is the key element in the screening process for COPD. The
to improvements in COPD treatment.
25
There is no nationwide purpose of the screening procedure is to find smokers with COPD
screening programme for COPD because mass screening of the total and motivate them to stop smoking or ‘trigger’ quit attempts.
smoking population with spirometry has been controversial and not Smoking cessation can be performed by professional smoking
regarded as feasible.
26
In a random sample of people between 25 and cessation therapy (behavioural or motivational support in small
30 EUROPEAN RESPIRATORY DISEASE
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