Chest
Volume 125, Issue 4, April 2004, Pages 1394-1399
Journal home page for Chest

Clinical Investigations
COPD
Office Spirometry Significantly Improves Early Detection of COPD in General Practice: The DIDASCO Study

https://doi.org/10.1378/chest.125.4.1394Get rights and content

Study objectives

To determine if spirometry is essential for the early detection of COPD in general practice, compared to the screening value of a short questionnaire.

Methods

A prospective survey of the population aged 35 to 70 years visiting their general practitioner (GP) during a 12-week period, using a questionnaire on symptoms of obstructive lung disease (OLD). Spirometry was performed in all participants with positive answers and in a 10% random sample from the group without complaints. Twenty GPs were provided with a hand-held spirometer, and received training in performance and interpretation of lung function tests. All 35- to 70-year-old patients (n = 3,408) were screened for current use of bronchodilators. The subgroup receiving bronchodilators (n = 250, 7%) was assumed to have OLD, and was excluded. Airflow obstruction was defined according to the European Respiratory Society standards.

Results

The positive predictive power of the questionnaire was low (sensitivity, 58%; specificity, 78%; likelihood ratio, 2.6). One hundred twenty-six cases of formerly unknown OLD were detected in the group of patients with complaints, vs an extrapolated number of 90 in the group without complaints. Despite a negative predictive value of 95% for the questionnaire used, 42% of the newly diagnosed cases of OLD would not have been detected without spirometry.

Conclusions

The use of a spirometer is mandatory if early stages of OLD are to be detected in general practice. Screening for airflow obstruction almost doubles the number of known patients with OLD.

Section snippets

General Design of the Study

The target population for early detection of COPD was defined as the age group from 35 to 70 years. The participating GPs were asked to screen every patient in this age group attending clinic at least once during 12 successive weeks for use of bronchodilators and/or inhaled steroids, since they were assumed to have known asthma or COPD. All other subjects were to complete a short questionnaire pointing to signs and symptoms of OLD (Table 1). Patients with at least one positive answer were given

Demographic Data

During a period of 12 weeks from April to July 1999, 22 GPs applied the case-finding algorithm to all of their visiting patients (n = 3,408) aged 35 to 70 years. Two hundred fifty patients (7.3%) used bronchodilators and/or inhaled steroids, and were assumed to have asthma or COPD. The other 3,158 subjects were submitted to the short questionnaire. Seven hundred twenty-eight responders (23%) gave at least one positive answer, indicating that they had a higher probability of OLD. From this

Discussion

The present study demonstrates that spirometry in general practice is feasible and sufficiently accurate. In the target population aged 35 to 70 years, we found 7.4% of patients with formerly unknown OLD. Of these patients, 42% would not have been found without the screening with spirometry. The degree of airflow obstruction was mild to moderate.

Conclusion

The present study shows that spirometry in general practice is feasible provided that the GPs are instructed and trained in the use of a hand-held spirometer. The accuracy of their measurements was found to be highly acceptable. The GPs were able to incorporate spirometry in their daily routines.

If early detection of OLD is to be realized in general practice, the use of a spirometer is essential. Detection based on the use of a questionnaire appeared to be insufficient.

These conclusions could

ACKNOWLEDGMENT

We thank the GPs who participated in the registration: P. Bastaerts, M. Biervliet, P. Boeykens, B. Bruynbroeck, L. De Moor, P. De Ridder, A.M. Deleenheer, L. Frisch, R. Gors, M. Joossens, H. Marechal, L. Martens, C. Micholt, G. Opsomer, W. Renier, A. Roex, M. Roex, I. Tambuyzer, P. Tarpataki, D. Van Achter, D. Van de Sijpe, and L. Van Parijs. We are very grateful to P. Vermeire, C. Van Weel, and C. P. Van Schayck for reviewing the study design.

References (22)

  • G Van den Boom et al.

    Under presentation of shortness of breath in the general population: results of the DIMCA programme

    Asthma Gen Pract

    (1999)
  • Cited by (221)

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    Financial support was provided by Boehringer Ingelheim Belgium.

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