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Obstructive Lung Diseases |

Improving Clinical Diagnosis of COPD in Primary Care: Results of a Cluster-Randomized Controlled Study Utilizing a Screening Questionnaire With or Without a Handheld Spirometric Device Compared With Usual Care

Barbara Yawn*, MD; Karen Duvall, MD; John Peabody, MD; Frank Albers, MD; Ahmar Iqbal, MD; Stephen Koval, MD; Heather Paden, MD; William Wadland, MD
Author and Funding Information

Olmsted Medical Center, Rochester, MN


Chest. 2012;142(4_MeetingAbstracts):735A. doi:10.1378/chest.1387426
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Abstract

SESSION TYPE: COPD: Diagnosis and Evaluation

PRESENTED ON: Sunday, October 21, 2012 at 01:15 PM - 02:45 PM

PURPOSE: COPD is often not diagnosed or diagnosed in later stages. Earlier diagnosis and intervention can lead to improved quality of life and physical functioning, fewer exacerbations, and lower mortality. The Screening, Evaluating and Assessing Rate CHanges of Diagnosing Respiratory Conditions in Primary Care (SEARCH) prospective cluster-randomized study assessed a symptom-based COPD population screener [COPD-PS] questionnaire with/without FEV1/FEV6 assessment by use of a handheld spirometric device [copd-6] to identify undiagnosed patients with COPD.

METHODS: US primary care practices from seven states were randomized into three arms: Arm 1: COPD-PS plus copd-6 (if ≥5 score on the COPD-PS); Arm 2: COPD-PS alone; Arm 3: usual care. Sites received no additional training on COPD diagnosis and were not informed about the other arm interventions. Up to 55 consecutive subjects without a COPD diagnosis, aged ≥40 years, were recruited at each site. Data were abstracted from subjects’ medical charts 8 weeks after study enrollment visit. The primary endpoint was the rate of new COPD diagnoses within 8 weeks after enrollment; the secondary endpoint was diagnostic practice pattern after screening at study enrollment visit (new COPD diagnosis, referral for spirometry, referral to pulmonologist, new respiratory medication prescription), in Arm 1 and Arm 2 vs Arm 3.

RESULTS: Of 9704 subjects (Arm 1: 3201; Arm 2: 3296; Arm 3: 3207 subjects), mean age 60.2 yrs, 40.6% males, 82.9% Caucasian, 8770 had no prior diagnosis of COPD. The rate of new COPD diagnoses within 8 weeks of Visit 1 was statistically significantly higher in Arms 1 and 2 than Arm 3 (Arm 1: 1.16%, P=0.0021 (Odds Ratio [OR] 2.4); Arm 2: 1.07%, P=0.0060 (OR 2.2); Arm 3: 0.49%). Diagnostic practice patterns did not significantly differ between arms.

CONCLUSIONS: Use of the COPD-PS and copd-6 resulted in higher rates of COPD diagnoses than usual care in this study, with combination screening having the highest yield.

CLINICAL IMPLICATIONS: Use of screening tools in primary care could facilitate diagnosis of COPD in primary care.

DISCLOSURE: Barbara Yawn: Consultant fee, speaker bureau, advisory committee, etc.: Barbara Yawn has received consultation fees from Boehringer-Ingelheim/Pfizer and research funding from Boehringer-Ingelheim/Pfizer, Novartis, GlaxoSmithKline and Merck related to chronic respiratory diseases.

Karen Duvall: Consultant fee, speaker bureau, advisory committee, etc.: Compensation received from Boehringer Ingelheim Pharmaceuticals Inc, Ridgefield, CT

John Peabody: Consultant fee, speaker bureau, advisory committee, etc.: Compensation received from Boehringer-Ingelheim Pharmaceuticals Inc, Ridgefield, CT

Frank Albers: Employee: Employee of Boehringer-Ingelheim Pharmaceuticals Inc, Ridgefield, CT

Ahmar Iqbal: Employee: Employee of Pfizer Inc, New York, NY

Stephen Koval: Employee: Employee of Boehringer-Ingelheim Pharmaceuticals Inc, Ridgefield, CT

Heather Paden: Employee: Employee of Boehringer-Ingelheim Pharmaceuticals Inc, Ridgefield, CT

William Wadland: Consultant fee, speaker bureau, advisory committee, etc.: Compensation received from Boehringer-Ingelheim Pharmaceuticals Inc, Ridgefield, CT

No Product/Research Disclosure Information

Olmsted Medical Center, Rochester, MN

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