Screen for COPD during annual reviews, say GP specialists

Patients with chronic diseases such as diabetes should be screened for COPD during their annual reviews, according to GP researchers.

The close monitoring of patients with existing conditions present an opportunity for earlier COPD identification (Photograph: SPL)
The close monitoring of patients with existing conditions present an opportunity for earlier COPD identification (Photograph: SPL)

A large DoH-backed UK study of almost 40,000 patients with COPD found a large proportion had been treated for conditions such as ischaemic heart disease and asthma in the two years prior to their initial COPD diagnosis.

The high prevalence led GP respiratory specialists to suggest that patients with a history of chronic illness should also be checked for COPD to improve detection of the disease.

Lead author and Norfolk GP Professor David Price of Aberdeen University presented the findings at the European Respiratory Society annual congress in Amsterdam on Monday. He said: 'These data confirm that active comorbidities are common at the time of COPD diagnosis.'

'The close monitoring of patients with existing conditions present an opportunity for earlier COPD identification and diagnosis.'

He suggested decision-support prompting on GP computer systems could flag up a patient with a past history of smoking and diabetes or ischaemic heart disease. These individuals could then undergo COPD screening to detect previously undetected COPD.

Researchers analysed 38,859 patient records from the General Practice and Optimum Patient Care research databases.

Patients aged over 40 years were included if they had received their first COPD Read code between 1990-2009. The findings show an average of 53.3% of patients had asthma over the 20 year span, although this fell from 71.1% to 29.7% over this period.

In the two years before they received a COPD diagnosis, 7.7% of patients consulted for ischaemic heart disease. During this time, 18.5% consulted, or were prescribed drugs for, gastroesophageal reflux disease (GERD) and 9.6% for diabetes.

The team also found that consultations for comorbidites prior to diagnosis rose over the course of the study period. Ischaemic heart disease leapt from 6.5% in 1990 to 11.5% in 2009. GERD went from 1.5% to 8.4% and diabetes from 4.4% to 12.5%.

Authors said the increase may be due to greater awareness and improved diagnosis of comorbidities among patients with COPD in recent years, potentially as a result of incentive schemes such as the QOF.

Professor Price said: 'Patients with COPD often die as a result of their comorbidities and not as a result of their COPD. It becomes very important to understand the comorbidities because this will help to quantify the extent of the disease burden of the patient with COPD.'

He concluded: 'These patients should be evaluated for COPD as part of their annual review.'

 

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