Molinari Nicolas, Abou-Badra Mathieu, Marin Grégory, Ky Chin-Long, Amador Noemi, Gamez Anne Sophie, Vachier Isabelle, Bourdin Arnaud
Département de l'Information Médicale. Hôpital La Colombière, CHU Montpellier, Montpellier, France.
PhyMedExp, University of Montpellier, INSERM U1046, CNRS UMR 9214, Montpellier, France.
BMC Pulm Med. 2015 Apr 28;15:44. doi: 10.1186/s12890-015-0039-6.
COPD is largely under-diagnosed and once diagnosed usually at a late stage. Early diagnosis is thoroughly recommended but most attempts failed as the disease is marginally known and screening marginally accepted. It is a rare cause of concern in primary care and spirometry is not very common. Exhaled carbon monoxide (eCO) is a 5-seconds easy-to-use device dedicated to monitor cigarette smoke consumption. We aimed to assess whether systematic eCO measurement in primary care is a useful tool to improve acceptance for early COPD diagnosis.
This was a two-center randomized controlled trial enrolling 410 patients between March and May, 2013. Whatever was the reason of attendance to the clinic, all adults were proposed to measure eCO during randomly chosen days and outcomes were compared between the two different groups of patients (performing and not performing eCO). Primary outcome was the rates of acceptance for COPD screening.
Rate of acceptance for COPD screening was 28% in the eCO group and 26% in the other (P = 0.575). These rates increased to 48 and 51% in smokers (current and former). eCO significantly increased the rate of clinics during which a debate on smoking was initiated (42 vs. 24%, P = 0.001). eCO at 2.5 ppm was the discriminative concentration for identifying active smokers (ROC curve AUC: 0.935). Smoking was the only independent risk factor associated with acceptance for early COPD screening (OR = 364.6 (82.5-901.5) and OR = 78.5 (18.7-330.0) in current and former smokers, respectively) while eCO measurement was not.
Early COPD diagnosis is a minor cause of concern in primary care. Systematic eCO assessment failed to improve acceptance for early COPD screening.
慢性阻塞性肺疾病（COPD）在很大程度上未得到充分诊断，一旦确诊通常已处于晚期。强烈建议进行早期诊断，但大多数尝试均告失败，因为该疾病鲜为人知，筛查也未被广泛接受。在初级保健中，它是一个罕见的关注原因，肺功能测定并不常见。呼出一氧化碳（eCO）是一种用于监测香烟烟雾摄入量的5秒易用设备。我们旨在评估在初级保健中进行系统性eCO测量是否是提高早期COPD诊断接受度的有用工具。
这是一项两中心随机对照试验，于2013年3月至5月招募了410名患者。无论就诊原因如何，所有成年人都被建议在随机选择的日子测量eCO，并比较两组不同患者（进行和未进行eCO测量）的结果。主要结局是COPD筛查的接受率。
eCO组中COPD筛查的接受率为28%，另一组为26%（P = 0.575）。吸烟者（当前吸烟者和既往吸烟者）的这些比率分别增至48%和51%。eCO显著提高了引发吸烟讨论的诊所比率（42%对24%，P = 0.001）。2.5 ppm的eCO是识别当前吸烟者的判别浓度（ROC曲线AUC：0.935）。吸烟是与早期COPD筛查接受度相关的唯一独立危险因素（当前吸烟者和既往吸烟者的OR分别为364.6（82.5 - 901.5）和78.5（18.7 - 330.0）），而eCO测量并非如此。
早期COPD诊断在初级保健中是一个次要关注原因。系统性eCO评估未能提高早期COPD筛查的接受度。
