A New Approach To Detect COPD In Primary Care Settings

A diverse research group, led by Fernando J Martinez of Cornell Medical College, New York, has found that a novel approach in primary care setting can help identify COPD patients.

Abbreviated for chronic obstructive pulmonary disease, CODP can be timely diagnosed by primary setting clinician after giving the patients a simple questionnaire to fill, followed by observation with peak expiratory flow (PEF) meter.

The research which carries significant clinical implications for doctors and COPD patients alike, was also recently published in American Journal of Respiratory and Critical Care Medicine.

Currently, more than 12 million Americans are diagnosed with COPD and it has emerged as the third leading cause of death in the country over the years. The National Heart, Lung, and Blood Institute of the NIH estimates that another 12 million people suffer from COPD but are unaware of the condition.

These undiagnosed cases of COPD are a prime factor requiring an early disease diagnosis tool. In this context, the director of the Division of Lung Diseases at NHLBI said that this simple practice can help clinicians improve healthcare for people whose COPD goes unnoticed.

These cases go unnoticed only to get diagnosed when the damage becomes irreversible.

He said, “The hope is that by finding individuals with COPD at an earlier stage of illness, we might be able to offer them treatments which can improve their disease. NHLBI’s support of the research that led to this tool exemplifies the ongoing commitment of NHLBI to COPD research.”

According to the COPD detection with this tool, the patients have to complete a COPD Assessment in Primary Care to Identify Undiagnosed Respiratory Disease and Exacerbation Risk (CAPTURETM). The questionnaire contains five questions to evaluate irritant exposure, current breathing problems, history of acute respiratory illnesses and how quickly the person gets tired.

Shortlisted from a proposed 44 questions, collected by the patients of COPD, the five more relevant questions included the following:

  • Have your ever lived or worked in a place with dirty or polluted air, smoke, second-hand smoke or dust?
  • Does your breathing change with seasons, weather, or air quality?
  • Does your breathing make it difficult to do things such as carry heavy loads, shovel dirt or snow, jog, play tennis, or swim?
  • Compared to others your age, do you tire easily?
  • In the past 12 months, how many times did you miss work, school, or other activities due to a cold, bronchitis or pneumonia?

Responding to the answers provided by the patients, high risk group is referred to further diagnostic tests. Patients with moderate or low risk symptoms are not further examined. Similarly, the patients whose risk levels lie somewhere in the middle are asked to take a PEF test. After this test, males who exhale less than 350 liters/minute and females who exhale less than 250 liters/minute of air are referred to further testing.

While observing the results obtained from this tool in a clinical trial, the researchers observed that out of 346 participants with an average age of 63, 52% participants fell in the group requiring PEF test. Similarly, the questionnaire results along with PEF tests showed high sensitivity for both men and women, further validating the test tool’s utility.

What Leads To COPD?

COPD is a progressive respiratory disease which makes it hard for a sufferer to breathe properly. The disease, as it exacerbates, is characterized by chest tightness, coughing with large amounts of mucus, shortness of breath and wheezing.

COPD is caused majorly by tobacco smoking and exposure to lung irritants which may include chemicals, air pollution and dust. As a person inhales this toxic air, they are unknowingly causing serious damage to their lungs. This toxic air crosses through the windpipe into the bronchial tubes of the lungs, leading to the numerous smaller tubes called bronchioles which further branch into alveoli. These tiny air sacs have a network of blood capillaries which run along them for gaseous exchange into and out of the bloodstream.

Now that a person is persistently exposed to lung irritants for a stretch of years, the quantity of air flowing into the lungs decreases leading towards inefficient gaseous exchange in the lungs. This reduced amount of air flowing into the lungs can be a consequence of one of the many conditions. These conditions include reduced elasticity of the airways and air sacs, wearing out of the air sac walls, inflammation and thickening of walls in the airways and clogging of airways due to increased mucus secretion.

In the US, emphysema and chronic bronchitis are the most common causes of CODP, which are marked by damaged air sac walls and inflamed airway lining, respectively.

Progressing gradually, the disease often goes undiagnosed which upon aggravating can hamper routine activities like commuting, cooking and even looking after yourself independently.

What makes it worse is that it currently has no cure and clinicians do not know if the damage cause can be reversed. Currently, lifestyle modification is the only way of slowing down the disease progress, once diagnosed.

Currently, the US Preventive Services Task Force recommends against the screening of COPD using spirometry. From the evidence, the task force concluded that diagnosis and early treatment for COPD has no significant benefit on preventing the disease. It was further added that the cost and time spent on these tests would outweigh the benefits, if any present. Additionally, it will lead to over-diagnosis of the disease and giving false positive results in healthy adults.

However, with the surfacing of this study, we may see some revisions to the US Preventive Services Task Force recommendations in future and better COPD diagnosis at early stage.

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