The article regarding early diagnosis of COPD1 was of particular interest, as our practice has recently implemented a Structured Systematic Screening Programme for the Early Detection of COPD. Patients are identified by case finding in routine surgeries and in both current and ex-smokers, those calculated to be ‘at-risk’ (over 40 years, with history of 15-pack-years or greater)2 are subsequently invited for spirometry with the specialist nurse practitioner. This also triggers smoking cessation advice if appropriate. After 10 months, 56% of the target population have their risk documented, and of those, 45% have undergone spirometry. Thirty-five per cent of patients on the current COPD register were diagnosed through this initiative; an increase of 54% on the register held at the start, supporting beliefs that COPD is grossly under-diagnosed and consequently under-treated.3
As a large and increasing cause of worldwide mortality and morbidity, COPD cannot be ignored. Actively targeting those at risk allows optimal management and specific health promotion for example, vaccination. Recent work also suggests that diagnosing early airways obstruction in asymptomatic smokers does increase cessation rates,4 thus preventing disease progression, and fuelling the argument that initiatives such as this are indeed of great health and economic benefit, and should be more widely employed.
- © British Journal of General Practice, 2006.