An effective COPD case finding strategy in Primary Care Fragkoulis Evangelos, Kyriakaki A, Papathanasiou M, Economou N, Maragiannis K, Mariolis A

Clinical COPD is just the tip of the iceberg…

Background COPD remains widely underdiagnosed worldwide Early identification of COPD would be beneficial to reduce costs, loss of quality of life, and premature death the most effective case finding approach is still unknown

Who to target? “A clinical diagnosis of COPD should be considered in any patient who has dyspnea, chronic cough or sputum production, and a history of exposure to risk factors for the disease” GOLD – updated 2016

Methods a pilot study to evaluate the effectiveness of an opportunistic, targeted screening program for COPD in Primary Care. Patients from different types of general practice settings (urban, semi-urban and rural) were included- Athens (centre, suburbs), Mani, Rhodes – 5GPs/ each GP enrolled 50 patients patients were invited opportunistically at routine primary care visits High risk patients for COPD targeted (smokers, having ≥1 respiratory symptom) Smoking status Smokers completed a questionnaire about chronic respiratory symptoms (i.e. cough, sputum production, wheezing and dyspnea) and a short validated COPD screener questionnaire.

The COPD Population Screener™ (COPD-PS™) an easy-to-use, validated tool designed to identify patients at risk for COPD • Score 5-10: High risk of COPD • Score 0-4: Low risk of COPD

eligibility criteria ≥ 40 years smokers or ex-smokers ≥1 respiratory symptom present (dyspnea, cough, wheeze or phlegm) no previous diagnosis of COPD Eligible patients were offered a spirometry

Diagnosis of COPD Spirometry is required to make a clinical diagnosis of COPD post-bronchodilator FEV1/FVC < 0.70 confirms the presence of persistent airflow limitation and thus of COPD • Mild COPD: FEV1 <80% of expected • Moderate COPD: 50%< FEV1 <80% of expected • Severe COPD: 30%< FEV1 <50% of expected GOLD- updated 2016

Results 250 patients were included. 213 had an acceptable spirometry (47 Female, 22%) From them, 82 patients (38.5%) were diagnosed with COPD (FEV1 / FVC <70%) The majority of them had mild (41,4%) or moderate (48,7%) obstruction The number needed-to-screen (NNS) for a new diagnosis of COPD was 2,6

Conclusion Targeting those at higher risk (e.g., smokers) and pre-screening (e.g., using questionnaires) consist a highly effective and feasible strategy to identify undetected patients with COPD in Primary Care.