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Simple tool based on five questions helps identify possible COPD patients

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A simple tool developed by pulmonary care experts could help practice nurses and GPs to identify many more patients with chronic obstructive pulmonary disease, according to research from the US.

The new approach involves asking people five key questions as well as using a peak expiratory flow (PEF) meter to measure breathing for some.

“The researchers created and tested a simple tool that may help practitioners improve care”

James Kiley

Research published in the American Journal of Respiratory and Critical Care Medicine suggests the method successfully helps identify those at risk of COPD, so they can be referred for further diagnostic tests.

In the first instance, patients complete a simple questionnaire called CAPTURE – COPD Assessment in Primary Care To identify Undiagnosed Respiratory Disease and Exacerbation Risk.

Anyone whose answers indicate they are at high risk of COPD will be sent for more tests. Those deemed to be at medium risk will do a PEF test and those with results below a certain threshold are also referred for more tests.

Researchers whittled down the crucial questions from more than 40 to just five with help from patients with or at risk of COPD, including those who had been recently diagnosed.

“Primary care clinicians were emphatic – it could not be a long and complicated questionnaire”

Fernando Martinez

In their case-controlled study of 346 men and women, the researchers found that 52% of participants required PEF to determine if further diagnostic testing was required.

The questionnaire plus PEF had a high rate of sensitivity (89.7%) and specificity (78.1%) for cases versus controls, including those with mild COPD. The sensitivity was similar, but the specificity rose to 93.1% when cases were compared to non-COPD controls.

They concluded: “CAPTURETM with PEF can identify COPD patients who would benefit from currently available therapy and require further diagnostic evaluation.”

Lead author Dr Fernando Martinez, head of pulmonary and critical care medicine at the Weill Cornell Medical College in New York, said input from patients and primary care clinicians was key in the tool’s development.

“Primary care clinicians were emphatic – it could not be a long and complicated questionnaire and we could not include complex pulmonary function testing upfront,” he said.

“We as clinicians did not expect some of the questions to be included but they resonated with patients,” he added.

Patients are not asked directly about past or current smoking habits, but are asked if they have ever lived or worked somewhere with dirty or polluted air, smoke, second-hand smoke or dust.

Weill Cornell Medical College

Simple five-question tool helps find COPD patients

Fernando Martinez

Dr Martinez suggested not asking directly about smoking history was “less pejorative” – reducing the risk of clinicians coming across as disapproving – and potentially identified more instances of exposure.

Other questions include whether patients’ breathing changes with the seasons, weather or air quality, and whether they feel they tire more easily compared to other people their age.

The hope is the tool will go on to be tested in a much bigger study involving about 5,000 patients across 75 primary care sites.

The study was funded by the US National Heart, Lung and Blood Institute.

Dr James Kiley, director of the lung disease division at the institute, said: “The researchers created and tested a simple tool that may help practitioners improve care by finding people who have COPD but didn’t know it.

”The hope is that by finding individuals with COPD at an earlier stage of illness, we might be able to offer them treatments which can improve their disease,” he added.

The five final questions used in the CAPTURE tool are:

  1. Have your ever lived or worked in a place with dirty or polluted air, smoke, second-hand smoke or dust?
  2. Does your breathing change with seasons, weather, or air quality?
  3. Does your breathing make it difficult to do things such as carry heavy loads, shovel dirt or snow, jog, play tennis, or swim?
  4. Compared to others your age, do you tire easily?
  5. In the past 12 months, how many times did you miss work, school, or other activities due to a cold, bronchitis, or pneumonia?
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