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

2. Clinical COPD is just the tip of the iceberg…

3. 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

4. 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

5. 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.

6. 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

7. 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

8. Diagnosis of COPD
Spirometry is required to make a clinical diagnosis of COPD
post-bronchodilator
FEV1/FVC < 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

9. 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

10. 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.