Screening Tool Results Show Difficulty of Identifying Patients With COPD

Amid efforts to develop improved screening tools that can help physicians identify and treat more patients with chronic obstructive pulmonary disease (COPD), the COPD Assessment in Primary Care to Identify Undiagnosed Respiratory Disease and Exacerbation Risk (CAPTURE) screening tool was able to identify almost half of patients who had moderate to severe forms of undiagnosed COPD, according to recent study findings.

“The goal with trying to find COPD is to treat it earlier, which will help make patients feel better and hopefully prevent their disease from progressing,” Fernando J. Martinez, MD, a principal investigator of the study and chief of the Pulmonary and Critical Care Medicine division at Weill Cornell Medicine, said in a statement.¹

The results of this multiyear clinical trial (NCT03581227) were published in JAMA.²

More than 15 million individuals in the United States have a diagnosis of COPD, a leading cause of death. This study aimed to identify more patients who may have COPD but have yet to be diagnosed or treated.

This study included 4325 patients (ages 45-80 years) from 7 US clinical research centers who enrolled in the study between October 2018 and April 2022. The participants underwent screening for COPD, which was how the researchers were able to measure the tool’s effectiveness.

Of the patients, 44.6% ever smoked cigarettes, 13.2% were current smokers, 10% reported at least 1 cardiovascular comorbidity, and 18% reported a diagnosis of asthma or used inhaled respiratory medicines.

This screening tool, which is already being used by some physicians, was composed of 5 evaluations: air quality (exposure to polluted air, smoke [including second-hand smoke], or dust); breathing changes with seasons, weather, or air quality; breathing difficulty with activity; tiring more easily compared with others of the same age; and missing work/school or other activities from having a cold, bronchitis, or pneumonia.

Patients with moderate scores (2-4) were asked to take an in-office breathing test to measure peak expiratory flow rate (PEFR). Men with PEFR scores lower than 350 L/min and women with scores lower than 250 L/min qualified for spirometry COPD testing, considered the “gold standard” for diagnosing COPD. Participants with higher scores (5-6) were immediately qualified for COPD testing.

Altogether, 110 participants (2.5%) had moderate to severe COPD, with CAPTURE being able to identify 53 (48%) of all cases. It reported false positives for 479 participants (11%). Furthermore, CAPTURE was estimated to help identify 1 out of 81 patients with treatable but undiagnosed COPD.

The researchers acknowledged that this screening tool was meant to identify patients with COPD symptoms and not to diagnose them. However, the results of this study suggest that simple screening tools for COPD may provide physicians with information needed to further assess a patient with respiratory symptoms when spirometry testing is being underutilized.

Larger CAPTURE research is currently working to examine the efficacy and usefulness of this screening tool in a physician-based setting.

“The study shows that there is a high degree of respiratory burden in primary care, and physicians need to ask about it and do the appropriate testing to determine if symptoms are driven by COPD or another process so that patients can get the right treatment,” MeiLan K. Han, MD, a principal investigator of the study and a professor of medicine in the Division of Pulmonary and Critical Care at the University of Michigan, said in an additional statement.

References

1. Screening tool aims to help doctors diagnose more people with COPD. News release. EurekAlert! Accessed February 13, 2023. https://www.eurekalert.org/news-releases/979403

2. Martinez FJ, Han MLK, Lopez C., et al. Discriminative accuracy of the CAPTURE tool for identifying chronic obstructive pulmonary disease in US primary care settings. JAMA. Published online February 14, 2023. doi:10.1001/jama.2023.0128