Home or surgery based screening for chronic obstructive pulmonary disease (COPD)?

To compare the effectiveness of opportunistic spirometric screening of patients attending a general practice surgery with screening on randomly selected home visits.

100 patients aged 45+ attending the Honiton Surgery (surgery group) and 100 randomly selected patients visited at their homes (home group) were invited to perform spirometry and complete a symptom and medication questionnaire. Main outcome measures were successful completion of spirometry and questionnaire and an estimate of COPD prevalence.

Surgery assessments were successful in 94/100 (95% C.I. 89% to 99%) cases. Eighteen percent of those visited at home refused the invitation to attend for spirometry; 33% (95% C.I. 24% to 42%) resulted in a successful assessment; there was no. reply when visiting 46% of cases and 3% of he visits were refused or terminated on the day.The mean age of the surgery group and home group was 63.7 years and 64.5 years respectively. The mean time per patient was 17 minutes in the surgery group and 1 hour 26 minutes in the home group.Twenty five (27%, 95% C.I. 18% to 36%) of those assessed in the surgery group and 10 (30%, 95% C.I. 14% to 46%) of the home group had an FEV₁ < 80% predicted. Of these, 14/25 (56%) and 4/10 (40%) were current or ex-smokers. Of these, eight and three respectively had cough, wheeze or breathlessness, giving an overall COPD prevalence of 11/127 (9%, 95% C.I. 0% to 19%). Three of these eleven (27%) had mild disease, 7/11 (64%) moderate and 1/11 (9%) severe. The mean age of the patients with COPD was 70.8 years. Four of the eleven (36%) patients with COPD already had a diagnosis recorded in their records (3 COPD, 1 asthma). Analysis of surgery attendance (any health care professional) of all patients aged 45 and above, indicated that over a one year period 79.1% (95% C.I. 78.2% to 80.0%) and over a two year period 89% (95% c.i. 88.3% to 89.7%) of the total practice population attended on at least one occasion.

Opportunistic spirometric assessment of patients routinely attending surgery results in a high uptake; over a period of two years around 84% of the target population could be assessed. Home visiting may be used for reaching those not routinely attending the surgery.