Chronic Obstructive Pulmonary Disease Case Finding: Severity Grade at First Spirometry and Ongoing Therapy 12 Months...

Approximately 30% of chronic obstructive pulmonary disease (COPD) diagnoses at first spirometry are already at GOLD 3-4 grade of severity based on airflow obstruction with a FEV₁ <50% of predicted, in the more severe and resource consuming group. Therefore, as improving early COPD diagnosis, ideally at GOLD 1 grade (reported as <20%), is a strategic target, we promoted a quality-controlled spirometry in primary care setting on subjects at risk for COPD (with smoking habits ≥15 pack/years).

Subjects with a post bronchodilator FEV₁/FVC <0.7 were consecutively enrolled in an observational study (Structured Efficient E-Tracking [STREET] project) aiming to record ongoing COPD therapy after 12 months, and medication possession ratio (MPR).

Of the 397 enrolled subjects, only 15% were in GOLD 1 grade. When reporting ongoing therapy prescribed by general practitioners at 12 months, it was of interest that (a) a short-acting agonist as needed only was prescribed in 72% of GOLD 1 COPD subjects (85% with an mMRC ≤1, class A), (b) a long-acting beta agonist (LABA)/inhaled corticosteroid (ICS) combination was prescribed in 21% of GOLD 2-3 COPD subjects, although without any exacerbation (class A or B). When checking adherence to prescribed therapy, an MPR ≥80% was detected in less than 30% of subjects at GOLD 1-3 grade.

The main findings of our study are that (a) about 80% of COPD subjects underwent spirometry for the first time too late, at GOLD 2-3 grade; (b) 21% of those at this grade were prescribed a LABA/ICS combination not compliant with the GOLD document; and (c) adherence to prescribed therapy was low at GOLD grade 1-3.