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Targeted Case - identification screening can help reduce the burden of COPD

COPD remains significantly under-diagnosed, with diagnosis commonly missed or delayed until disease is advanced. A growing body of evidence suggests that early detection of airflow limitation and intervention for smoking cessation can delay lung function decline, reduce the burden of COPD symptoms, and improve patients’ quality of life.

Targeted, systematic case-identification in primary care has been proposed as a strategy to improve diagnosis rates and enable early detection and management, including aggressive smoking cessation efforts.

The aims of spirometry performed for case-identification purposes are to exclude those with normal lung function and identify those who require more complete investigation for COPD. In this context, spirometry protocols and standards will differ from those of spirometry performed for the purpose of achieving a definitive diagnosis. For case-identification, it is acceptable to perform a less specific but relatively sensitive test - that is, to proceed by exclusion. Suitable spirometry parameters are forced expiratory volume in one second (FEV1), ratio of FEV1 to forced vital capacity (FVC), and ratio of FEV1 to forced expiratory volume in 6 seconds (FEV6).

The IPCRG emphasises that &lssquo; case-identification’ spirometry must not replace standard diagnostic spirometry, which must be performed according to internationally accepted standards set by the European Respiratory Society (ERS) and American Thoracic Society (ATS).

Spirometry in primary care case-identification, diagnosis and management of COPD *David Price, Alan Crockett, Mats Arne, Bernard Garbe, Rupert Jones, Alan Kaplan, Arnulf Langhammer, Siân Williams, Barbara Yawn.