A multidisciplinary approach to screening for chronic obstructive pulmonary disease (COPD) may be feasible and could improve the uptake of smoking cessation initiatives in at-risk patients, according to findings from a pilot study published in Respiratory Medicine and Research.
The pilot study included participation from several different clinicians and healthcare providers (HCPs) relevant to COPD screening and care, including general practitioners, pharmacists, dentists, physiotherapists, and nurses. The 45 HCP volunteers formed a group of field investigators who underwent a 1-day training session delivered by specialized chest physicians (n=2), a nurse, and a pharmacist. Education focused on local epidemiological data, characteristics of high-risk COPD populations, global COPD management, smoking substitution, and proper use of a portable spirometer.
In addition to the field investigators, the study also enrolled people aged 40 years and above who were active smokers (more than 10 packs/year), all of whom were considered at high risk of COPD by the field investigators. Participants filled in a COPD screening self-assessment test as well as a smoking dependence test. Additionally, participants were asked to perform a spirometry using the COPD-6 screening device using “an acceptable technique” 3 times.
Patients with normal spirometry results were advised on the importance of smoking cessation and were referred to a specialized center or service to curb smoking. In contrast, patients with abnormal spirometry values were given an intervention that consisted of a dedicated appointment with a general practitioner or a chest physician.
At 2 months, the field investigator and the patient spoke to each other by phone, text message, or email to evaluate the interventions. From April 2017 to July 2018, a total of 157 participants (mean age, 54 years; 53% female) filled in the questionnaires and performed spirometry. A total of 35 patients were screened by a general practitioner, 35 were screened by a nurse, 24 were screened by a pharmacist, 37 were screened by a physiotherapist, and 26 were screened by a dentist.
Approximately 22% (n=35; 95% CI, 15.8-28.8) of the participants had airflow obstruction, as detected by a forced expiratory volume (FEV) in 1 second/FEV in 6 seconds of less than 0.7 with the COPD-6 device. Pharmacists diagnosed airflow obstruction in 37% of patients (95% CI, 10.2-39.5), general practitioners in 26% (95% CI, 11.2-40.2), physiotherapists in 24% (95% CI, 10.5-38.2), nurses in 14% (95% CI, 2.7-25.9), and dentists in 8% (95% CI, 0.1-17.9).
The average lung age of patients was 66 years, which was significantly higher than that of birth age (P <.001). Approximately 43% (n=68; 95% CI, 35.5-51.1) of participants were engaged in a smoking cessation program at the 2-month follow-up, while 14% (n=22; 95% CI, 8.6-19.4) reported complete smoking cessation.
Those screened by dentists and general practitioners more frequently participated in a smoking cessation program (odds ratio [OR], 0.39; 95% CI, 0.2-0.7; P =.01). Additionally, participants included by dentists were significantly more likely to quit smoking (OR, 0.25; 95% CI, 0.1-0.7; P =.01). Higher motivation to stop smoking was associated with normal lung age at enrollment (OR, 0.3; 95% CI, 0.1-0.6, P <.001) but not at 2 months.
The researchers concluded that “this pilot study suggested that a predefined screening of COPD by different healthcare professionals could be implemented in primary care and might be part of counselling for smoking cessation.”
Hourmant B, Gobert CG, Plumet R, et al. Screening for COPD in primary care, involving dentists, pharmacists, physiotherapists, nurses and general practitioners (the UNANIME pilot study). Respir Med Res. Published online August 2, 2021. doi:10.1016/j.resmer.2021.100853