Early detection of COPD in primary care – The Copenhagen COPD screening project

Background: Chronic Obstructive Pulmonary Disease (COPD) is among the leading causes of death in the world. Delay in diagnosing COPD appears common even though current consensus guidelines emphasize the importance of early detection. Aim: To evaluate the effectiveness of a 2-stage-screening programme in primary care. Methods: Subjects aged 65+ registered with a general practitioner (GP) in eastern Copenhagen received a simple questionnaire asking for smoking status and symptoms of COPD and an invitation to undergo spirometry at their GP or at a local health care centre if they were smokers, former smokers or if any of the following signs were present: morning cough with sputum and/or dyspnoea. Results: A total of 7103 subjects participated in the study. Of these 5767 subjects returned the questionnaire (81.2%), with 58.5% of the subjects being at risk of COPD. Of the 45 general practices in the study area, 10 did not perform spirometry. Subjects listed with one of these practices were told to contact a local health care centre for spirometry. The participation rate among subjects at risk of COPD was 35% in general practice and 60% at the local health care centre. In total 1352 subjects had spirometry performed. Of these 44% were diagnosed with COPD according to the GOLD classification. COPD was classified as mild in 252 (42.3%), moderate in 258 (43.3%) and severe to very severe in 86 subjects (14.4%). Conclusion: The study shows that a short, mailed questionnaire based on patient-reported information can serve as a first-level screening tool for the identification of subjects at risk of COPD. However, the organisation of spirometry seems important for the participation rate.