COPD case finding. Severity Grade at First Spirometry and Ongoing Therapy 12 Months After Initial Diagnosis.

Aim. Approximately 30% of COPD diagnoses at first Spirometry are already at GOLD 3-4 grade of severity based on airflow obstruction with a FEV1<50% of predicted, in the more severe and resource consuming group. Therefore, as improving early COPD diagnosis, ideally at GOLD 1 grade (reported as <20%), is a strategic target, we promoted a quality-controlled Spirometry in Primary Care setting on subjects at risk for COPD (with smoking habits ≥15 pack/years). Methods. Subjects with a post bronchodilator FEV1/FVC <0.7 were consecutively enrolled in an Observational Study (STructured Efficient E-Tracking, STREET project) aiming to record ongoing COPD therapy after 12 months, and Medication Possession Ratio (MPR). Results. Of the 397 enrolled subjects, only 15% were in GOLD 1 grade. When reporting ongoing therapy prescribed by GPs at 12 months it was of interest that a) a short-acting Agonist (SA) as needed only was prescribed in 72% of GOLD 1 COPD subjects (85% with an mMRC≤1, class A), b) a Long-Acting Beta Agonist (LABA)/Inhaled Corticosteroid (ICS) combination was prescribed in 21% of GOLD 2-3 COPD subjects, although without any exacerbation (class A or B). When checking adherence to prescribed therapy, an MPR≥80% was detected in less than 30% of subjects at GOLD 1-3 grade. Conclusions. The main findings of our study are that a) about 80% of COPD subjects underwent spirometry for the first time too late, at GOLD 2-3 grade, b) 21% of those at this grade were prescribed a LABA/ICS combination not compliant with the GOLD document, and c) adherence to prescribed therapy was low at GOLD grade 1-3.