Screening smokers with spirometry for chronic obstructive pulmonary disease (COPD) picks up more cases than symptom-based detection, research suggests.
The authors say the findings highlight the need for more screening in primary care, which is seldom used at present.
"Despite current and updated GOLD [Global Initiative for Chronic Obstructive Lung Disease] guidelines that recommend case-finding studies for early diagnosis of COPD, the present study showed that a screening program aimed at all smokers may also be a positive strategy if economic resources are available," say Raul Sansores (Instituto Nacional de Enfermedades Respiratorias, Mexico City, Mexico) and colleagues.
The study included 1999 participants who underwent spirometry after reporting symptoms of cough, phlegm, wheezing, and shortness of breath, and 782 participants recruited from a smoking cessation program. All participants were current or former smokers with a cumulative past consumption of at least 10 pack-years.
A significantly greater proportion of participants in the screening group were classified as having COPD according to the GOLD classification compared with the symptom-based group (13.3 vs 10.1%).
Dyspnea was the most common symptom in the two groups, occurring in 56% in the symptom-based group and 55% in the screening group. Regression analyses showed that it was the only risk factor that predicted COPD in both strategies, being associated with a two-fold increase in the odds of diagnosis compared with patients without it. Meanwhile, patients in the symptom-based group had a significantly higher incidence of cough, phlegm, wheezing, and history of bronchitis and emphysema than the screening group.
The authors say that previous studies have shown that spirometry is often not performed on smokers or patients presenting with symptoms. This has led to an underestimation of the worldwide prevalence of COPD, as well as missed opportunities for early treatment.
"All lines of evidence overwhelmingly demonstrate that the identification of smokers (with or without symptoms) may also be useful, not only to detect an important number of smokers with COPD but also to increase awareness about COPD, to prevent its development, to encourage smoking cessation and to decrease the potential risk of death," they conclude in Respiratory Medicine.
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