PURPOSE: To determine the prevalence of COPD in a community based spirometry screening program. Chronic Obstructive Pulmonary Disease (COPD) is the 4th leading cause of death in the United States but fewer than half of COPD cases are detected. Early diagnosis using spirometry combined with smoking cessation or removal from exposure can significantly slow the progression of the disease.
METHODS: A year-long public health study of free spirometry testing to assess the prevalence of COPD in Cook and surrounding Illinois counties was implemented. Volunteer respiratory care practitioners were given 4 hours of training on Puritan Bennett Renaissance II spirometers. Subjects were recruited at a national pharmacy chain for a “free lung test” to rule out COPD. A questionnaire eliciting respiratory symptoms, smoking history and exposure history was obtained. Spirometry was performed according to ATS 1994 acceptability and reproducibility criteria and interpreted by pulmonologists. Obstructive defects were categorized according to the GOLD criteria.
RESULTS: 1819 subjects were studied out of which 1265 (70%) had interpretable spirometry. The mean age was 57, 36% were men, 88% were white and half were current or former smokers who had a mean tobacco exposure of 24 pack years. 14% of subjects had significant impairment GOLD COPD category 2 or greater, and 3% had severe or very severe impairment. 60 (67%) of 89 of these impaired subjects in whom complete questionnaire data was available (n=567) were not aware of a previous diagnosis of obstructive lung disease (COPD or asthma). Logistic regression analysis showed that variables which predicted the presence of COPD with impairment were total pack years of tobacco smoke exposure and age (p<.000). BMI had a slight negative predictive value (p<.05).
CONCLUSION: Large scale spirometry screening for COPD can be successfully performed in community settings. A large proportion of subjects with significant impairment were newly diagnosed.
CLINICAL IMPLICATIONS: Mass screening spirometry presents an opportunity to identify early COPD and intervene in disease progression.
DISCLOSURE: Robert Cohen, None.