Julius Center for Health Sciences and Primary care, University Medical Center Utrecht, Utrecht, the Netherlands
Julius Center for Health Sciences and Primary care, University Medical Center Utrecht, Utrecht, the Netherlands.
Eur Respir J. 2014 Dec;44(6):1571-8. doi: 10.1183/09031936.00074614. Epub 2014 Jun 12.
It is uncertain whether screening of older persons for chronic obstructive pulmonary disease (COPD) is worthwhile because the effects on patient management and prognosis are unknown. We aimed to assess the short-term consequences of detecting COPD in frail elderly subjects with dyspnoea, considering pulmonary drug use, hospitalisations and all-cause mortality. Community-dwelling frail elderly subjects, aged 65 years and older, with dyspnoea, participating in a screening study on COPD and heart failure were included. Final diagnoses were assigned by an expert panel based on all data from the screening strategy, including spirometry. Follow-up data were collected from the general practitioners. Of the 386 patients, 84 (21.8%) were received a new diagnosis of COPD. Overall, changes in pulmonary drug prescription during 6 months of follow-up were infrequent (n = 53, 13.7%; among new cases of COPD, 15 (17.9%) out of 84). Of all participants, 25.9% were hospitalised in the first year of follow-up, with the highest rate in patients with newly detected COPD (32.1%). Many new cases of COPD could be detected by screening frail elderly subjects with dyspnoea, but the impact on patient management seems limited. Our study underlines the importance of obtaining follow-up data to assess the true impact of a (screen-detected) diagnosis of COPD on patient management and outcome.
对于老年人群进行慢性阻塞性肺疾病（COPD）筛查是否有意义尚不确定，因为其对患者管理和预后的影响尚不清楚。我们旨在评估在有呼吸困难症状的虚弱老年患者中检测 COPD 的短期后果，考虑到肺药物使用、住院和全因死亡率。纳入了参加 COPD 和心力衰竭筛查研究的、有呼吸困难症状的、居住在社区的虚弱老年患者。最终诊断由一个专家小组根据筛查策略的所有数据（包括肺量测定）确定。随访数据由全科医生收集。在 386 名患者中，84 名（21.8%）被新诊断为 COPD。总体而言，在 6 个月的随访期间，肺药物处方的变化很少（n = 53，13.7%；在新诊断的 COPD 中，84 例中有 15 例（17.9%））。在所有参与者中，有 25.9%在随访的第一年住院，新发现的 COPD 患者的住院率最高（32.1%）。通过对有呼吸困难症状的虚弱老年患者进行筛查，可以发现许多新的 COPD 病例，但对患者管理的影响似乎有限。我们的研究强调了获得随访数据以评估（筛查发现的）COPD 诊断对患者管理和结局的真正影响的重要性。
