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Screening for COPD: the gap between logic and evidence

Chronic obstructive pulmonary disease (COPD) is a common disease leading to further morbidity and significant mortality. The first step for any condition is to make the appropriate diagnosis, and spirometry barriers abound in practice around the world. It is tempting to undertake mass screening on a...

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Autores principales: Kaplan, Alan, Thomas, Mike
Formato: Online Artículo Texto
Lenguaje:English
Publicado: European Respiratory Society 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9489098/
https://www.ncbi.nlm.nih.gov/pubmed/28298389
http://dx.doi.org/10.1183/16000617.0113-2016
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author Kaplan, Alan
Thomas, Mike
author_facet Kaplan, Alan
Thomas, Mike
author_sort Kaplan, Alan
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description Chronic obstructive pulmonary disease (COPD) is a common disease leading to further morbidity and significant mortality. The first step for any condition is to make the appropriate diagnosis, and spirometry barriers abound in practice around the world. It is tempting to undertake mass screening on all smokers to detect COPD. While this would pick up cases of COPD, results of studies of its effect on COPD end-points such as exacerbations, hospitalisations and mortality are disappointing. As such, aggressive case finding of COPD by screening for symptoms that patients may not themselves perceive is very important in primary care, with subsequent spirometry defining the diagnosis. We also have to separate out population screening from individual patient interactions. Performing spirometry, even on a truly asymptomatic patient, may allow earlier diagnosis and modification of risk factors such as smoking (mostly) and exacerbation risk. It also recognises patients with early disease who are at high risk of comorbidities such as cardiac illness, such that appropriate treatment strategies can be implemented. Making a diagnosis, and even the fact of worrying about such a diagnosis, can affect the motivational level of the individual patient to cease smoking; all patients should of course be counselled to stop smoking. As such, consider the individual patient in front of you for unrecognised symptoms and therefore unrecognised illness, as making a diagnosis earlier can allow the institution of care, including smoking cessation, vaccination, bronchodilators and comorbidity management.
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spelling pubmed-94890982022-11-14 Screening for COPD: the gap between logic and evidence Kaplan, Alan Thomas, Mike Eur Respir Rev Mini-review: Health and Politics Chronic obstructive pulmonary disease (COPD) is a common disease leading to further morbidity and significant mortality. The first step for any condition is to make the appropriate diagnosis, and spirometry barriers abound in practice around the world. It is tempting to undertake mass screening on all smokers to detect COPD. While this would pick up cases of COPD, results of studies of its effect on COPD end-points such as exacerbations, hospitalisations and mortality are disappointing. As such, aggressive case finding of COPD by screening for symptoms that patients may not themselves perceive is very important in primary care, with subsequent spirometry defining the diagnosis. We also have to separate out population screening from individual patient interactions. Performing spirometry, even on a truly asymptomatic patient, may allow earlier diagnosis and modification of risk factors such as smoking (mostly) and exacerbation risk. It also recognises patients with early disease who are at high risk of comorbidities such as cardiac illness, such that appropriate treatment strategies can be implemented. Making a diagnosis, and even the fact of worrying about such a diagnosis, can affect the motivational level of the individual patient to cease smoking; all patients should of course be counselled to stop smoking. As such, consider the individual patient in front of you for unrecognised symptoms and therefore unrecognised illness, as making a diagnosis earlier can allow the institution of care, including smoking cessation, vaccination, bronchodilators and comorbidity management. European Respiratory Society 2017-03-15 /pmc/articles/PMC9489098/ /pubmed/28298389 http://dx.doi.org/10.1183/16000617.0113-2016 Text en Copyright ©ERS 2017. https://creativecommons.org/licenses/by-nc/4.0/ERR articles are open access and distributed under the terms of the Creative Commons Attribution Non-Commercial Licence 4.0.
spellingShingle Mini-review: Health and Politics
Kaplan, Alan
Thomas, Mike
Screening for COPD: the gap between logic and evidence
title Screening for COPD: the gap between logic and evidence
title_full Screening for COPD: the gap between logic and evidence
title_fullStr Screening for COPD: the gap between logic and evidence
title_full_unstemmed Screening for COPD: the gap between logic and evidence
title_short Screening for COPD: the gap between logic and evidence
title_sort screening for copd: the gap between logic and evidence
topic Mini-review: Health and Politics
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9489098/
https://www.ncbi.nlm.nih.gov/pubmed/28298389
http://dx.doi.org/10.1183/16000617.0113-2016
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