BMJ 2002;324:1370 ( 8 June )

Primary care

Detecting patients at a high risk of developing chronic obstructive pulmonary disease in general practice: cross sectional case finding study

C P van Schayck, professor, ^a J M C Loozen, general practitioner, ^a E Wagena, health scientist, ^a R P Akkermans, statistician, ^c G J Wesseling, pulmonologist. ^b

^a Department of General Practice, Research Institute ExTra, University of Maastricht, Postbox 616, 6200 MD Maastricht, Netherlands, ^b Department of Pulmonology, University of Maastricht, ^c Department of General Practice and Family and Social Medicine, University Medical Centre St Radboud, Nijmegen, Netherlands

Correspondence to: C P van Schayck Onno.vanschayck{at}hag.unimaas.nl

Objectives: To investigate the effectiveness of case finding of patients at risk of developing chronic obstructive pulmonary disease, whether the method is suitable for use in general practice, how patients should be selected, and the time required.
Design: Cross sectional study.
Setting: Two semirural general practices in the Netherlands.
Participants: 651 smokers aged 35 to 70 years.
Main outcome measures: Short standardised questionnaire on bronchial symptoms for current smokers, lung function with a spirometer, and the quality of the spirometric curve.
Results: Of the 201 smokers not taking drugs for a pulmonary condition, 169 produced an acceptable curve (fulfilling American Thoracic Society criteria). Of these, 30 (18%, 95% confidence interval 12% to 24%) had a forced expiratory volume in one second (FEV₁) <80% of predicted. When smokers were preselected on the basis of chronic cough, the proportion with an FEV₁ <80% of predicted increased to 27% (17 of 64; 12% to 38%). Chronic cough was a better predictor of airflow obstruction than other symptoms, such as wheeze and dyspnoea. The presence of two symptoms was a slightly better predictor than cough only (odds ratio 3.02 (1.37 to 6.64) v 2.50 (1.14 to 5.52)). Age was also a good predictor of obstruction; smokers over 60 with cough had a 48% chance of having an obstruction. The mean time needed for spirometry was four minutes. Detecting one smoker with an FEV₁ <80% of predicted cost 5 to 10.
Conclusions: Trained practice assistants could check all patients who smoke for chronic obstructive pulmonary disease at little cost to the practice. Cough and age are the most important predictors of the disease. By testing one smoker a day, an average practice could identify one patient at risk a week.

What is already known on this topic The number of patients with chronic obstructive pulmonary disease continues to increase Screening a practice population for the disease is not feasible Smoking is a known risk factor for patients developing the disease What this study adds Case finding of chronic obstructive pulmonary disease by examining smokers is effective and can be implemented in general practice Cough and age are good predictors of the disease in smokers Practice assistants can measure lung function at low cost

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© BMJ 2002

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