ABS60: Use of spirometry for early recognition of COPD in smokers

Abstract

Introduction:

Some studies have been published on COPD screening with spirometry in primary care. Most of them are based in small samples and ideal situations. They are not representative of primary health care daily routine and do not usually perform reversibility testing.

Aims and objectives:

Early detection of COPD in smokers using office spirometry in a real primary care setting. Subjects and method: Smokers aged 40–69 visiting their doctor were included. We excluded patients with previous diagnosis of pulmonary disease, those with inhaled medication and with spirometry in the previous year. A descriptive study measuring socio-demographic variables, smoking habit and life-accumulated tobacco dose, MRC dyspnoea scale and other respiratory symptoms through patient interviews. Spirometry before and after inhaling a dose of 400 micrograms of salbutamol measured FVC, FEV1, FEF 25-75, FEM and FEV1/FVC ratio.

Results:

212 patients were included, mean age 51 years. 52% were men, 71'3% active working, 26 pack-years on average. 206 tests with reversibility measurement were completed. 33 of them were not valuable. From the remaining 179 valid and negative reversible tests, 35 (20%) fulfilled COPD GOLD criteria. Prevalence was higher in men (28'4% vs 13'2% in women) (p=0'017). Mean age and tobacco packs-year were higher in COPD patients (p= 0'026, p = 0'14). Fifty four per cent were mild; moderate 43%; and 3% severe. 14 patients with normal spirometry had respiratory symptoms (GOLD 0). Only cough was more frequent in patients with COPD (51'4% vs 28%) (p < 0'009).

Conclusions:

Screening of COPD with spirometry and reversibility testing is feasible in current general practice. Increasing age, tobacco exposure and cough are good predictors for a positive diagnosis of COPD. Reversibility testing does not add great value to spirometry for COPD screening.

Conflict of interest and funding

None.