Chapron Anthony, Andres Emilie, Fiquet Laure, Pelé Fabienne, Allory Emmanuel, Le Pabic Estelle, Veislinger Aurélie, Le Guillou Lisa, Guillot Stéphanie, Laviolle Bruno, Jouneau Stéphane
Department of General Practice, University of Rennes, Centre Hospitalier Universitaire (CHU) Rennes, Rennes; UMR_S 1085, Institut National de la Santé et de la Recherche Médicale (INSERM), Institut de Recherche en Santé, Environnement et Travail (IRSET), Rennes.
Department of General Practice, University of Rennes, CHU Rennes, Rennes; CIC-1414, INSERM, Rennes.
Br J Gen Pract. 2023 Nov 30;73(737):e876-e884. doi: 10.3399/BJGP.2022.0565. Print 2023 Dec.
Worldwide, chronic obstructive pulmonary disease (COPD) remains largely underdiagnosed.
To assess whether the use of Global Initiative for Chronic Obstructive Lung Disease (GOLD) questions and COPD coordination, either alone or combined, would detect new COPD cases in primary care.
GPs in Brittany, France, systematically enrolled patients aged 40-80 years over a 4-month period in this French multicentre cluster randomised controlled study.
GPs were randomly allocated to one of four groups: control (standard of care), GOLD questions (adapted from symptoms and risk factors identified by GOLD), COPD coordination, and GOLD questions with COPD coordination. New cases of COPD were those confirmed by spirometry: post-bronchodilator forced expiratory volume in 1 second over forced vital capacity of <0.7.
In total, 11 430 consultations were conducted by 47 GPs, who enrolled 3162 patients who did not have prior diagnosed asthma or COPD. Among these, 802 (25%) were enrolled in the control, 820 (26%) in the GOLD questions, 802 (25%) in the COPD coordination, and 738 (23%) in the GOLD questions with COPD coordination groups. In the control group, COPD was not evoked, and no spirometry was prescribed. All new cases of COPD diagnosed ( = 24, 0.8%) were in the intervention groups, representing 6.8% of patients who performed spirometry. Statistically significantly more new cases of COPD were detected with COPD coordination ( = 0.01).
Interventions that can be easily implemented, such as the GOLD questions and COPD coordination, can identify new cases of COPD. Studies are needed to identify the most appropriate case-finding strategies for GPs to detect COPD in primary care for each country.
在全球范围内，慢性阻塞性肺疾病（COPD）在很大程度上仍未得到充分诊断。
评估单独使用慢性阻塞性肺疾病全球倡议（GOLD）问题或COPD协调，或两者结合，是否能在初级保健中发现新的COPD病例。
在这项法国多中心整群随机对照研究中，法国布列塔尼的全科医生在4个月内系统招募了40 - 80岁的患者。
全科医生被随机分配到四组之一：对照组（护理标准）、GOLD问题组（根据GOLD确定的症状和危险因素改编）、COPD协调组以及GOLD问题与COPD协调组。COPD新病例通过肺功能测定确诊：支气管扩张剂后1秒用力呼气容积与用力肺活量之比<0.7。
47名全科医生共进行了11430次会诊，招募了3162名既往未诊断哮喘或COPD的患者。其中，802名（25%）被纳入对照组，820名（26%）被纳入GOLD问题组，802名（25%）被纳入COPD协调组，738名（23%）被纳入GOLD问题与COPD协调组。对照组未提及COPD，也未开具肺功能测定检查。所有确诊的COPD新病例（n = 24，0.8%）均在干预组，占进行肺功能测定患者的6.8%。COPD协调组检测到的COPD新病例在统计学上显著更多（P = 0.01）。
像GOLD问题和COPD协调这样易于实施的干预措施能够识别COPD新病例。需要开展研究以确定每个国家全科医生在初级保健中检测COPD的最合适病例发现策略。
