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At the heart of general practice since 1960

COPD screening set to double practice workload

By Nigel Praities

Plans for a national programme of ‘lung health checks' are set to double the number of patients diagnosed with COPD, figures produced for the Department of Health reveal.

Advisers to the upcoming national service framework on COPD are recommending a two-stage approach to screening for the disease, with questionnaires followed by spirometry for high-risk patients.

Details of the screening proposals – first revealed by Pulse earlier this year – have yet to be decided, but a new evaluation suggests they will have major workload implications.

Research from the East of England Public Health Observatory used a model based on patient data on age, sex, ethnicity, smoking and location from the Health Survey for England to estimate the true prevalence of COPD.

The study found an expected prevalence of around 2.8% in the general population, compared with a prevalence of 1.4% for the 2006/7 QOF. In adults over 15 years, expected prevalence increased to 3.8%.

Researchers said assessing the risk factors included in the study using questionnaires was a potential model for targeted screening in primary care. They are discussing their data with representatives from the NSF this month.

Dr Julian Flowers, acting director for the East of England Public Health Observatory, said the research showed there was potential to identify a lot of younger patients in particular whose COPD symptoms had been missed. ‘I have a slight reservation about doing wholesale nationwide checks, whereas this model could identify those at greater risk. This kind of targeting could be run on practice computers or used in a questionnaire,' he said.

Research indicates targeted COPD screening yields a high proportion of COPD cases in primary care. In one pilot, targeting spirometry at smokers over 40 found up to a fifth had undiagnosed COPD.

Professor David Price, an adviser to the NSF for COPD and professor of primary care respiratory medicine at the University of Aberdeen, said the actual prevalence of COPD was double or treble that currently seen in primary care.

‘We need to focus on case-finding; identifying those with COPD and then spirometry,' he said.

Professor Price, who works as a GP in Norfolk, played down fears over the effect on practice workload. ‘You are looking at identifying about 100 patients a year for the average practice list of 12,000,' he said.

COPD screening

May 07 - Trial finds 10-20% of smokers over 40 have undiagnosed COPD
Nov 07 - British Lung Foundation estimates 2.8 million people have undiagnosed COPD and calls for screening of over-35s
Jan 08 - Prime Minister Gordon Brown calls for earlier intervention in long-term conditions and Pulse reveals lung health checks will be part of NSF for COPD
Apr 08 - Research reveals COPD prevalence could be double that in general practice

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