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Approximately 70 percent of patients with chronic obstructive pulmonary disease (COPD) or asthma are undiagnosed. But according to a recent study published in the New England Journal of Medicine, a unique approach to finding these patients in their homes may help address this diagnostic gap and improve outcomes.

Background on the Study

To help find undiagnosed patients with COPD or asthma, researchers called random telephone numbers at 17 study locations in Canada between 2017 and 2023. They used an automated message to find out if any adults in that particular household experienced any of the following unexplained symptoms over the course of the previous 6 months:

• Shortness of breath
• Wheezing
• Prolonged cough
• Coughing up mucus

26,905 individuals responded yes and then completed questionnaires. Spirometry breathing tests were also administered to those who were most likely to have COPD or asthma. Based on those test results, 595 patients either had undiagnosed COPD or asthma.

Out of that total, 508 agreed to participate in a multicenter, randomized, controlled trial. To assess whether early diagnosis and treatment would have any impact on healthcare utilization for respiratory illness and health outcomes, 253 of the participants received guideline-based care from a pulmonologist and an asthma-COPD educator, and 255 received usual care provided by their primary care provider.

Participants in the former group, known as the intervention group, were prescribed inhalers and obtained education on how to use them and manage disease flare-ups as well as smoking cessation treatment, exercise, weight counseling, and, when appropriate, pneumonia and flu vaccines. 92 percent of these participants also began new medications, compared to 60 percent in the usual care group.

The primary outcome of the study was the rate at which participants initiated healthcare utilization for respiratory illness over the course of a year.

Secondary outcomes included:

• Changes from baseline in disease-specific quality of life based on the St. George Respiratory Questionnaire (SGRQ)
• Symptom burden based on the COPD Assessment Test (CAT)
• Forced expiratory volume in 1 second (FEV₁)

For reference, lower scores on both of the SGRQ and CAT assessments equate to better health status.

Results of the Study

In terms of the primary outcome, the rate of healthcare utilization was lower in the group receiving care from a pulmonologist and an asthma-COPD educator at 0.53 visits versus 1.12 visits in the usual care group.

For the secondary outcomes, the SGRQ score was 10.2 points lower than the baseline score in the intervention group and 6.8 points lower in the usual care group. When compared to baseline, the CAT score was also lower by 3.8 points and 2.6 points, respectively.

Lastly, the intervention group’s FEV₁ increased by 119 microliters, and the usual care group’s FEV₁ increased by 22 microliters.

It’s also important to note that the incidence of adverse events was similar in both groups.

Implications of the Study

Based on these findings, utilizing automated calls may be an effective way to identify undiagnosed patients with COPD or asthma. And once those patients are identified, taking a more specialized approach to care can help reduce healthcare visits in addition to improve patient outcomes.

References:

Aaron SD, Vandemheen KL, Whitmore GA, et al. Early Diagnosis and Treatment of COPD and Asthma — A Randomized, Controlled Trial. New England Journal of Medicine. May 19, 2024. Accessed May 22, 2024. https://www.nejm.org/doi/full/10.1056/NEJMoa2401389.  

Kreimer S. Asthma, COPD often not diagnosed, study indicates. UPI. May 19, 2024. Accessed May 22, 2024. https://www.upi.com/Health_News/2024/05/19/canada-asthma-COPD-study/9771715982524/.