Affiliations: University of Thessaly, Larissa, Greece,
Katholieke Universiteit Leuven, Leuven, Belgium
Correspondence to: Nikolaos Z. Tzovaras, MD, 11 Kanari Str, 41222 Larissa, Greece; e-mail: firstname.lastname@example.org
To the Editor:
Recently, Buffels et al (April 2004)1demonstrated that spirometry is an effective screening tool in the detection of COPD in general practice, especially in its early stages, even in patients who underestimate and do not report any relative symptoms. The sensitivity of spirometry is raised when spirometry is conducted as a screening tool in high-risk populations, such as smokers, especially for the early detection of COPD.2 Our group recently conducted a similar study in primary care centers in central Greece. We examined approximately 1,000 subjects who were > 45 years of age with or without respiratory symptoms. Our first results showed that 9.6% of examined subjects received the diagnosis of COPD for the first time after responding to a specific questionnaire, and undergoing a physical examination and spirometry. This represented 42% of the total number of COPD patients. The percentage of subjects with COPD was 51.9% in the subgroup of smokers with a smoking history of > 10 pack-years.
Other important results derived from our study were as follows: (1) 35% of COPD patients who have already received a diagnosis have never undergone spirometry; (2) 40% of patients with moderate-to-severe COPD did not receive regular prescribed medication; (3) an excessive and unjustified use of home oxygen therapy, nebulizers, and inhaled corticosteroids was noticed in patients who were in the early stages of the disease; and (4) the annual per-patient cost for COPD medication is estimated at 897 Euro, starting at 413 euros in patients with stage I disease, rising to 892 euros in patients with stage III disease, and 1948 euros in patients with stage IV disease.3These results demonstrate not only the underdiagnosis of COPD in patients in the primary care health-care system but also their mistreatment, a fact that reflects the increases in the social and economic burden of the disease.4–5
It is obvious that much more has to be done in order to design strategies for the improvement and motivation of prevention policies, early detection, diagnosis, and management of COPD patients at all levels of health care, especially in the provision of primary health care, in order to reduce the economic impact of COPD.
We thank Dr. Tzovaras and colleagues for their comments on our article about office spirometry in CHEST1 and would like to respond. The authors mentioned a study conducted in Greece, and designed for case finding of COPD in general practice. I was unable to find their published data, and I would be happy to be informed about their methodology. The way in which a diagnosis of asthma was ruled out in the study population could be particularly important. It seems hazardous to reply on the results of the Greek study without knowledge of its details.
Dr. Tzovaras wrote that his study demonstrated the mistreatment of a number of COPD patients in the primary health-care system. It is obvious that the adherence to guidelines for the management of COPD can be improved, but other surveys have indicated that this is not a privilege of primary care.2 Besides, we need more evidence for the reduction of the economic impact of COPD attained by early detection of the disease. If Tzovaras and colleagues demonstrated that 40% of the patients with moderate-to-severe COPD did not receive regularly prescribed medication, the cost of future treatment could possibly exceed the economic benefit of early detection.
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