Community Case-Finding Identifies Undiagnosed COPD and Asthma, Improving Outcomes

Jun 20, 2024

Photo Credit: Kenishirotie

Community case-finding can identify undiagnosed COPD or asthma, with subsequent guideline-directed therapy by pulmonologists or primary care improving health outcomes.

Patients with undiagnosed COPD or asthma can be found in the community by targeting their symptoms using case-finding. Once they are identified, guideline-directed therapy by a pulmonologist or, to a lesser extent, usual care by a primary care practitioner can improve people’s health situation.

“Up to 70% of the patients with COPD or asthma remain undiagnosed in the community,” claimed Dr. Shawn Aaron, MD, FRCPC, from the Ottawa Hospital Research Institute, in Canada. “The US national health and nutritional examination survey of 2007–2012 revealed that 13% of the randomly selected adults had obstructive lung disease, with 71% being undiagnosed.” Next, a study that was published in December 2023 showed that people with undiagnosed COPD or asthma have a poorer quality-of-life, a greater need for healthcare utilization, and poorer work productivity, compared with healthy age-matched controls. Here, the UCAP study (NCT03148210), short for ‘undiagnosed COPD and asthma in the population’ aimed to answer three questions related to this clinical problem:

Can we find adults with undiagnosed asthma or COPD in the community?
Are these patients ill?
Can these patients be treated early to improve health outcomes?

Through case-finding, 2,857 adults with respiratory symptoms and no history of diagnosed lung disease underwent spirometry, revealing that 21% of them had undiagnosed asthma or COPD. To answer the last question, 508 patients with previously undiagnosed asthma or COPD were randomly assigned 1:1 to a guideline-based treatment, provided by a pulmonologist and asthma/COPD educator, or to usual care, provided by the patients’ primary care practitioner. The primary outcome was the annual rate of patient-initiated healthcare utilization events for respiratory illness. Dr. Aaron mentioned that 92% and 60% of the patients had started medication for COPD or asthma during the study in the ‘pulmonologist’ and ‘primary care practitioner’ arms, respectively. The incidence rate ratio for the primary outcome measure was 0.48 in favor of the ‘pulmonologist’ arm (P<0.001). Also, quality-of-life scores improved significantly in both groups over the 12-month study duration.

“We can improve healthcare utilization, symptoms, and quality-of-life in patients with undiagnosed COPD or asthma through guideline-directed treatment by a pulmonologist/educator,” summarized Dr. Aaron. “With usual care, the results are less remarkable but still significant. This is important because, in the real world, not everyone can see a lung specialist.”

Medical writing support was provided by Robert van den Heuvel.