Abstract
Aim: To compare the effectiveness of targeted versus opportunistic case finding for COPD in primary care.
Background: COPD is an increasing cause of morbidity and mortality, and underdiagnosis is common. The recent draft Clinical Strategy for COPD for the UK NHS recommended piloting case finding.
Methods: Patients from two general practices, aged between 35 and 79 years with a smoking history and no prior diagnosis of COPD or asthma were randomised to either a targeted or opportunistic case finding arm. Patients in the targeted arm were posted a respiratory questionnaire. Those in the opportunistic arm received a questionnaire when they next presented at their general practice over a 6 month period. Patients with positive symptoms were invited to attend spirometry. Those with an FEV1%predicted<80% and an FEV1/FVC<0.7 were diagnosed with airway obstruction and referred to their GP or specialist respiratory nurse.
Results: 351 (32.7%) of 1073 distributed questionnaires were returned. 247 (70.4%) participants who returned the questionnaire were symptomatic. Of those who underwent spirometry 14.3% were identified with airway obstruction. 10 out of 815 patients (1.23%) contacted in the targeted arm and 4 out of 258 (1.55%) in the opportunistic arm were identified with airway obstruction (difference 0.32%, 95% CI -1.37%, 2.01%). Overall 77 patients had to be contacted to identify one patient with airway obstruction; 82 in the targeted and 65 in the opportunistic arm.
Conclusion: 17 more patients had to be contacted in the targeted than in the opportunistic arm to identify one patient with airway obstruction in this pilot. Further work is needed with a wider range of practices to determine which approach is more efficient.
- © 2011 ERS