Respiratory Medicine
Volume 104, Issue 7 , Pages 1012-1019, July 2010

Preselection of patients at risk for COPD by two simple screening questions

  • Harald Kögler

      Affiliations

    • Medical Science Department, Respiratory Medicine, Boehringer Ingelheim Pharma GmbH & Co. KG, Ingelheim, Germany
  • ,
  • Norbert Metzdorf

      Affiliations

    • Medical Science Department, Respiratory Medicine, Boehringer Ingelheim Pharma GmbH & Co. KG, Ingelheim, Germany
  • ,
  • Thomas Glaab

      Affiliations

    • Medical Science Department, Respiratory Medicine, Boehringer Ingelheim Pharma GmbH & Co. KG, Ingelheim, Germany
  • ,
  • Tobias Welte

      Affiliations

    • Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany
    • Department of Respiratory Medicine, Medizinische Hochschule Hannover, Carl Neuberg Strasse 1, Hannover D-30625, Germany
    • Corresponding Author InformationCorresponding author. Department of Respiratory Medicine, Medizinische Hochschule Hannover, Carl Neuberg Strasse 1, Hannover D-30625, Germany. Tel.: +49 511 532 3530; fax: +49 511 532 3353.

Received 13 October 2009; accepted 10 January 2010. published online 08 February 2010.

Summary 

Background

The Burden of Obstructive Lung Disease study showed that in Germany, to confirm the diagnosis of chronic obstructive lung disease (COPD) in one subject, eight people ≥40 years of age have to be screened. The number-needed-to-screen (NNS) increased to 18 for identifying a patient with COPDGOLD stage II. These high numbers limit the cost-effectiveness of COPD screening by population spirometry. We investigated in a primary care setting whether using two simple questions regarding smoking status and presence of cough and/or dyspnea may help to preselect patients for proper diagnosis of COPD.

Methods

A total of 1088 patients aged ≥40 yrs without a history of chronic lung disease, who were either current or ex-smokers and complained of cough and/or dyspnea, were examined by respiratory physicians. Spirometry was carried out to confirm COPD diagnosis and severity.

Results

A total of 61.6% of patients were male. Mean smoking history was 31.8 pack-yrs. In 516 patients (47.4%), a diagnosis of COPD was confirmed. Among these, 379 (34.8% of total) had at least GOLD stage II COPD, while 89 (8.2% of total) had advanced disease (GOLD stages III/IV). COPD prevalence was significantly associated with age and the extent of cigarette smoke exposure.

Conclusions

Two questions regarding smoking status and presence of cough and/or dyspnea enabled general practitioners to select patients at risk for COPD for subsequent spirometry. This preselection reduced the NNS to 2.1 for identifying a COPD patient, and to 2.9 for identifying a patient of at least GOLD stage II.

Keywords: Chronic obstructive pulmonary disease, Screening, General practice

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PII: S0954-6111(10)00012-0

doi:10.1016/j.rmed.2010.01.005

Respiratory Medicine
Volume 104, Issue 7 , Pages 1012-1019, July 2010