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Simple, low cost tests enable early diagnosis of COPD - ‘Breathe Well’ findings published in BMJ Open

A simple questionnaire and airflow measurement test can help diagnose chronic obstructive pulmonary disease (COPD), according to research published this week in BMJ Open.

An international research team from the ‘Breathe Well’ project, part of the NIHR Global Health Research Group on Global COPD in Primary Care led by the University of Birmingham and Peking University Health Science Centre, conducted the research with 2,445 volunteers aged 40 years and above (mean age 59) at community health centres across China.

Formed in June 2017 funded by the National Institute for Health Research (NIHR), the Group has established partnerships with teams in Brazil, China, Georgia and North Macedonia, as well as the International Primary Care Respiratory Group. It is publishing a range of research findings this year, focusing on evaluating COPD screening strategies, promoting smoking cessation and improving disease management in primary care settings.

COPD is a long-term condition characterised by persistent breathing problems. It is estimated to affect around 1 in 10 of the world’s population, particularly older people, and is directly responsible for around  3.2 million global deaths every year. In China, the disease ranks among the top three leading causes of death, and an estimated 90% of adults with COPD in China are undiagnosed until the condition becomes serious and requires expensive hospital treatment. 

Co-author Professor Peymané Adab, from the University of Birmingham’s Institute of Applied Health Research, commented: “COPD is a global killer and we’re working with partners in China to improve ways of identifying those people who have the disease, but don’t realise it. 

“COPD develops slowly, resulting in delays in symptom recognition and high rates of underdiagnosis. Simple screening tests can help identify undiagnosed COPD within China’s primary care network - the first step in providing people with early treatment and potentially saving lives and reducing the burden on the country’s healthcare system.”

The 2,445 study participants were recruited from one urban and one rural community health centre in each of four municipalities: Beijing, Chengdu, Guangzhou and Shenyang. Residents aged 40 years and above attending for any reason were invited to participate. 

The study shows the Chinese symptom-based questionnaire combined with microspirometry – measuring how much air a patient can breathe out in one forced breath – could provide the most efficient way of identifying patients needing treatment for COPD such as health education, smoking cessation advice, influenza vaccination and inhalers. 

Co-author Dr Rachel Jordan, Reader in Epidemiology and Primary Care at the University of Birmingham, commented: “Worsening of COPD symptoms is a common and costly complication, often associated with irreversible loss of lung function, hospitalisation and death.

“Further work is needed to fully assess clinical efficiency and cost-effectiveness, but this simple combination of questionnaire and breathing test is a promising, low cost option to be used across China to provide early diagnosis of COPD.”

COPD screening programmes differ around the world, and the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines advocate active case-finding by performing spirometry in patients with symptoms and/or risk factors for COPD. Although spirometry is required for clinical diagnosis, it is not widely available in primary care settings in low and middle income countries. This study shows how low-cost screening strategies can help diagnose COPD earlier, save money and save lives.

This project has been funded by the Global Health Research Programme 

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