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COPD screening backed

By Eleanor Goodman

GP screening of smokers picks up one-fifth with undiagnosed COPD

Screening smokers for COPD identifies up to a fifth who have undiagnosed disease, a new primary care study reveals.

The research appears to strengthen the case for GP screening using spirometry, with proposals to be submitted for inclusion in the quality and outcomes framework.

Of 818 current or former smokers over the age of 40 screened for COPD, 19 per cent were found to have the disease. A substantial proportion of patients had moderate or severe disease, as measured by the GOLD severity criteria.

Researchers classified COPD as mild in 57 per cent of cases, moderate in 37 per cent and severe in 6 per cent. The study, published in February's Primary Care Respiratory Journal, examined spirometry screening results taken in practices in the UK and US.

Study leader Dr Robert Halbert, assistant professor of community health sciences at University College Los Angeles in the US, said: 'Earlier diagnosis through targeted case-finding will allow early, aggressive smoking cessation efforts. It may lead to a reduction in the burden of COPD symptoms.'

Dr Steve Holmes, chair of the General Practice Airways Group and a GP in Somerset, said the group would be submitting proposals for COPD screening to the QOF review.

'The research is very important and highlights clearly that we have a number of undiagnosed cases with COPD we're not managing early on. That fits in with a lot of the epidemiological research showing we have only picked up about a third of people. It builds on NICE guidance that screening people is a good idea.

'But he said GPs would need new resources if they were to take on screening. 'GP practices definitely have the skills and abilities to do this; the problem may be with resources and time, as this process isn't funded.'

Dr Mark Levy, editor of the Primary Care Respiratory Journal and a GP in Middlesex, said: 'It's a good piece of research, but are we really underdiagnosing people or are the criteria incorrect? According to the paper it's being undiagnosed, but that's based on the GOLD criteria.'

The GOLD guidelines used a fixed FEV1/FVC value of 0.70 to define airway obstruction, but a discussion paper in the same issue of the journal suggested the lower limit of normal would be a better classification.

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