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Physicians test screening tool for COPD in primary care

Article

COPD contributes to leading cause of death in U.S., but researchers say it may be underdiagnosed.

Physicians continue refining a screening tool to diagnose chronic obstructive pulmonary disease (COPD), “an underdiagnosed leading cause of death and morbidity” in primary care.

Researchers published new data on the COPD Assessment in Primary Care To Identify Undiagnosed Respiratory Disease and Exacerbation Risk screening tool, known as CAPTURE. It uses five symptom and exposure questions and, for some patients, peak expiratory flow rates to detect clinically significant COPD.

Among 4,325 patients in primary care, spirometry identified 110 patients with clinically significant COPD, and the CAPTURE tool caught 53 of those, for sensitivity of 48.2% and specificity of 88.6%. Clinically significant COPD was defined as patients having airflow obstruction of moderate severity or a history of acute respiratory illness.

“Overall, this study demonstrates the challenge of identifying undiagnosed patients with COPD in primary care,” said the study, “Discriminative Accuracy of the CAPTURE Tool for Identifying Chronic Obstructive Pulmonary Disease in US Primary Care Settings,” published in JAMA.

“We found that CAPTURE does pick up these people, but not all of them,” co-senior author Fernando Martinez, MD, MS, said in a news release. “It also picks up many other problems that we didn’t realize were so prevalent in primary care.”

Martinez, professor of internal medicine and chief of pulmonary and critical care medicine at Weill Cornell Medicine and New York-Presbyterian/Weill Cornell Medical Center, was part of a team that developed CAPTURE more than a decade ago. The most recent study examined results from October 2018 to April 2022.

CAPTURE also identified patients with breathing symptoms and abnormalities. Overall there were 532 patients questionnaires and breathing test scores indicated COPD or other issues such as chronic cough, sputum, or shortness of breath, study co-senior author Barry Make, MD, said in the news release.

COPD, encompassing conditions including emphysema and chronic bronchitis, is the largest contributor to chronic lower respiratory diseases, a leading cause of death in the United States. However, COPD may go undiagnosed in part because spirometry is not widely available, according to the researchers.

“Unfortunately, many patients with COPD go undiagnosed and are often not picked up until their disease is quite advanced,” study co-principal investigator MeiLan Han, MD, MS, said in the news release.

“As treatments for COPD improve, we have increasing ability to prevent morbidity and mortality among COPD patients,” said Han, chief of the Division of Pulmonary and Critical Care at the University of Michigan. “That’s why studies such as CAPTURE are so important to identify patients in primary care who would benefit from treatment.”

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