PURPOSE: Early diagnosis and management of chronic obstructive pulmonary disease (COPD) may control disease progression. Screening for COPD using spirometry has been studied in the primary care and community settings but limitations remain with availability and quality of testing. Patients presenting at a surgical pre-admission clinic may be referred for screening and detection of undiagnosed airways disease.
METHODS: We implemented a screening program within the surgical pre-admission clinic of a tertiary care university hospital in Montreal, Canada. Current or ex-smokers were questioned using the Canadian Lung Health Test to determine the presence of respiratory symptoms. Those screening positive on the questionnaire were administered a spirometry at our walk-in clinic. Patients with a history of COPD or asthma were also sent for pre-surgical spirometry regardless of smoking status. Patients referred for spirometry were included in this study. Spirometry results were classified according to Canadian Thoracic Society (CTS) guidelines. Charts were reviewed for history of airways disease and smoking status.
RESULTS: Between July 2010 - March 2011, 127 patients were referred for spirometry. Sixty (47%) were smokers, 38 (30%) were ex-smokers, and 29 (23%) were never-smokers. According to CTS criteria, 43 patients (35%) had abnormal spirometry. Fourteen (11%) had mild, 21 (17%) had moderate, and 8 (7%) had severe or very severe obstruction. Of these 43 patients, 22 (51%) represented new found cases of COPD, 17 (40%) had a known and confirmed diagnosis of COPD, and 4 (9%) patients did not have COPD. Of the 17 known COPD cases, 14 (82%) had at least moderate obstruction. Of the 22 newly found COPD cases, 14 (64%) had mild obstruction suggesting that these patients were diagnosed at an earlier stage of disease
CONCLUSIONS: Our data shows that an important number of patients with undiagnosed COPD are detected through a screening program within the pre-operative setting.
CLINICAL IMPLICATIONS: Through a simple pre-operative screening program, new COPD patients that would otherwise not have been detected can be appropriately managed.
DISCLOSURE: The following authors have nothing to disclose: Mark Palayew, Esther Dajczman, Chantal Robitaille, Andrew Hirsch, Debbie Gerson, David Small, Pierre Ernst
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