Early detection of COPD in primary care: the Copenhagen COPD screening project.

OBJECTIVE: To evaluate the effectiveness of a screening programme for COPD in primary care. MATERIAL/METHODS: Subjects aged 65 years or older registered with a general practitioner in Copenhagen were asked to complete a questionnaire on smoking status and symptoms of COPD. If they were smokers or former smokers or if morning cough with sputum and/or dyspnoea was present, subjects were defined as "at risk of COPD" and were invited to undergo spirometric examination. RESULTS: Of the 7103 subjects who met the study criteria, 81.2% responded to the questionnaire. Of these, 58.5% were at risk of COPD. Of those at risk, 40% underwent a spirometric examination. COPD was classified as mild in 252 (42.3%), moderate in 258 (43.3%) and severe-very severe in 86 subjects (14.4%). The participation rate was significantly higher among subjects invited for spirometry at a healthcare centre compared to general practice. CONCLUSIONS: Our findings suggest that a questionnaire can be used as a screening tool to identify subjects at risk of COPD. Furthermore, the study shows that more than half the subjects aged 65 years and above were at risk of COPD and required clinical assessment. Willingness to undergo spirometric examination depends on the location of the screening.

Every seventh acute medical admission is preventable.

INTRODUCTION: The majority of patients who are admitted to the departments of internal medicine are admitted acutely. The aim of this study was to evaluate the appropriateness of admissions to a community hospital in Copenhagen. MATERIAL AND METHODS: During a three-week period, all patients admitted to Bispebjerg Hospital's acute medical department (AMA) were consecutively included and retrospectively evaluated by a physician using the Appropriateness Evaluation Protocol (AEP). Based on the AEP criteria, admissions were categorized as appropriate or inappropriate. Uncertain admissions were evaluated and classified by three chief consultant physicians. RESULTS: A total of 470 patients were included, and 14% were classified as inappropriate. A total of 73 admissions failed to met any AEP criteria, and 131 admissions only meet one AEP criterion. Prior to admission, 365 patients were examined by the admitting doctor, and of patients not examined before admission, 17 were classified as inappropriate. A total of 30% of all patients admitted were discharged directly from the AMA within 24-48 hours, and 42 of those were inappropriately admitted. CONCLUSION: Our study shows that 14% of acute admissions could have been prevented. We found no evidence that preadmitting examination is important to prevent inappropriate admission. Several admissions could have been handled appropriately by a diagnostic unit or through sub-acute referral to an outpatient clinic the following day. The AEP is a useful screening instrument, but insufficient for the evaluation of the handling of acute medical patients. FUNDING: not relevant. TRIAL REGISTRATION: not relevant.

Pulmonary rehabilitation for moderate COPD (GOLD 2)--does it have an effect?

BACKGROUND: Although pulmonary rehabilitation is an integrated part of standard care in patients with severe COPD, it is uncertain whether those with less severe COPD benefit from such treatment. The aim of the present survey was to evaluate the effect of rehabilitation in patients with moderate COPD and to determine their willingness to participate in rehabilitation. MATERIAL AND METHODS: In a single-centre, randomized, placebo-controlled, unblinded clinical trial, participants comprised 61 of 133 referred subjects with moderate COPD. Of the 61 participants, 35 were randomized to receive rehabilitation and 26 subjects to receive standard COPD care from their GP. After randomization 19 subjects dropped out. RESULTS: Effects of physical training were seen during the period of intervention. Compared with those receiving standard GP care, those receiving rehabilitation showed improvements in walking distance and leg strength as well as improvements in quality of life; however, the effect was temporary, and at 18 months' follow-up there was no significant difference between the groups. Only 61 subjects of the referred group of 133 with moderate COPD accepted the offer of rehabilitation. CONCLUSION: Although an effect was found of pulmonary rehabilitation in subjects with moderate COPD, it disappeared over 18 months. Only a minority of patients with moderate COPD referred for rehabilitation accepted and completed the treatment offer.

Early detection of COPD in primary care--the Copenhagen COPD Screening Project.

BACKGROUND: Chronic Obstructive Pulmonary Disease (COPD) is among the leading causes of death in the world, and further increases in the prevalence and mortality are predicted. Delay in diagnosing COPD appears frequently even though current consensus guidelines emphasize the importance of early detection of the disease. The aim of the present study is to evaluate the effectiveness of a screening programme in general practice. METHODS/DESIGN: Subjects aged 65 years and older registered with a General Practitioner (GP) in the eastern Copenhagen will receive a written invitation and a simple questionnaire focusing on risk factors and symptoms of COPD. Subjects who meet the following criteria will be encouraged to undergo spirometric testing at their GP: current smokers, former smokers, and subjects with no smoking history but who have dyspnea and/or chronic cough with sputum. DISCUSSION: The Copenhagen COPD Screening Project evaluates the effectiveness of a two-stage screening program for COPD in general practice and provides important information on how to organize early detection of COPD in general practice in the future.