Challenge remains for early COPD detection in primary care

Exhaled carbon monoxide (eCO) testing in primary care has no effect on patient acceptance of screening for chronic obstructive pulmonary disease (COPD), research shows.

The findings also show that the method – a simple means to assess cigarette consumption – does little to encourage discussion between patients and their general practitioners (GPs) about the risk factors for developing the disease.

The results add to a growing body of evidence that suggests improving primary care access to spirometry may ultimately be the only way to increase early detection of COPD.

The researchers, led by Nicolas Molinari (CHU Montpellier, France), enrolled 410 patients attending two primary care offices for any reason. Of the patients, 23% were current smokers, 32% were former smokers and 45% had never smoked. Dependent on which day they attended, patients were randomly assigned to undergo eCO concentration testing or not.

The team found no significant difference in acceptance of referral for COPD screening between patients who did and did not undergo eCO testing. The only factor independently associated with acceptance of screening was smoking status.

The researchers write in BMC Pulmonary Medicine that they expected the assessment to lead to a discussion between patients and their GP about the consequences of smoking. However, they found the effect, while significant, was not as strong as they had anticipated.

In multivariate analysis, eCO testing was associated with a 2.6-fold increased odds of a debate about smoking. Nevertheless, only 42% of the 216 patients who underwent eCO assessment had such a discussion with their GP. This compared with 24% of those who did not undergo eCO assessment. Among ever smokers, these figures were 64% and 48%, respectively.

Molinari and colleagues say that the underdiagnosis of COPD is a major issue because it delays treatment and smoking cessation – the only meaningful way to interfere with the progress of the disease. However, early diagnosis is being held back worldwide due to lack of spirometry in primary care.

The researchers say their findings emphasise that lung specialists need to renew their efforts to share information about COPD with GPs and the wider public, if early detection of the condition is to increase.

Noting that attempts at alternative forms of primary care screening have also fallen short, they say: “Spirometry in primary care will probably be the next step to achieve the goal of early COPD screening.”

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