A standardised risk assessment tool would be both feasible and useful in general practice to assess the likelihood of patients in their 40s developing COPD in later life, it is being argued.
The case has been made by a team of respiratory physicians and GPs with a specific interest in lung health, who have developed such a tool and say it could have similar utility to those already in use for cardiovascular disease and type 2 diabetes.
While spirometry remains the gold standard first-line test before chest imaging, the COVID-19 pandemic and its aftermath have thrown up barriers to its use, point out the group, led by the respiratory physician and University of Melbourne epidemiologist Dr Jennifer Perret.
“Given the barriers of recommencing office/clinic spirometry in this living-with-COVID-19 era, this could be aided by triaging patients for pre- and post-bronchodilator spirometry through risk stratification,” they write in the Australian Journal of General Practice (link here).
Known as PRECURSOR, the model is based on validated questionnaire data from patients aged in their 40s and could be used in the 45- to 49-year-old health check or as a standalone tool, according to the group.
Only those with a sufficiently high score would then be selected for spirometry referral to confirm a diagnosis of COPD, say Dr Perret and her co-authors.
“Furthermore, providing different smoking scenarios of quitters compared with continuing smokers may be a critical motivating factor for smokers to quit,” the team adds.
“Obtaining an individualised risk prediction for any combination of history of smoking, asthma, job and symptom elicited by the risk tool is possible.”
The potential to detect declining lung function using targeted spirometry and provide interventions years before a patient develops CPD is currently “not commonly known” among GPs, they write.
As a result, many symptomatic patients with spirometric evidence of COPD remain undiagnosed in primary care settings, they add.
In addition, people with undiagnosed COPD are at increased risk of acute exacerbations, pneumonia and premature death, even if they do not have symptoms.
“Thus, we believe the lack of a suitable COPD risk assessment tool and a clear pathway to objective testing contribute to diagnostic delays and deferment of best practice respiratory care,” they write.
“This includes smoking cessation strategies, vaccination, COPD action plans, maintaining healthy weight and promotion of physical activity, as well as indicated pharmacotherapies.”