Screening smokers for COPD needs resources

GP respiratory specialists have called for a boost to primary care resources and changes to the quality framework to back smoking cessation efforts in patients with COPD.

The call follows UK research that showed there may be four people with undiagnosed COPD for every person over 35 with a respiratory disease diagnosis.   

For the study, 8,215 adults over 35 had smoking status confirmed with a salivary cotinine test and their lung function assessed with spirometry. This showed that only 18 per cent of patients with COPD confirmed by spirometry had a respiratory disease diagnosis.  

Less than half of those with severe or very severe COPD had received a respiratory diagnosis. Smokers with COPD were more dependent on nicotine, smoked more and had no more motivation to give up than smokers without lung disease.  

Dr Dermot Ryan, Leicester GP and member of the General Practice Airway Group, said: ‘Those currently diagnosed with COPD are just the tip of the iceberg, and this study shows that.’  

Diagnosis could improve if spirometers were used to screen smokers over 40 years old for COPD, he suggested. Many COPD patients are unwilling to present with respiratory symptoms because they do not want to be told to stop smoking.  

Research has suggested that these smokers required intensive intervention to help them give up and so stop their decline of lung function, he said.  

Somerset GP Dr Kevin Gruffydd-Jones, who has a special interest in respiratory disease, said detection of COPD in primary care needed to be included in the quality framework.  

‘Simple tools to identify those at high risk of COPD are being developed. Asking smokers over 35 if they cough or are breathless may be enough,’ he said.  

‘But unless there is an incentive to identify and manage patients it will not happen because most GPs already have too much on their plate.’  

Devon GP and respiratory specialist Dr Martin Mather said there was ‘a degree of nihilism’ among both patients and GPs. ‘There is a degree of collusion to support the idea of some patients that they do not deserve treatment because they have inflicted it upon themselves.’  

GPs need to be frank with patients, he said. ‘I ask whether they know what their condition is, and I explain that COPD is a disease that destroys lung tissue as a direct result of smoking.’

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