title: Detection of chronic obstructive pulmonary disease in primary care in Salzburg, Austria: findings from the real world.
abstract: BACKGROUND
  Chronic obstructive pulmonary disease (COPD) is a major public health burden and profoundly affects individuals suffering from the disease. However, the majority of subjects with COPD are still undiagnosed.
  
  
  OBJECTIVE
  To evaluate COPD prevalence and detection strategies for COPD in the primary-care setting.
  
  
  METHODS
  The study was conducted in a random sample of general practitioner (GP) offices in Salzburg (Austria). A questionnaire and post-bronchodilator (PBD) spirometry was administered to patients aged ≥ 40 years. Nonreversible airway obstruction was considered when PBD FEV1/FVC was <0.70. Severity of spirometrically defined COPD was graded according to the GOLD recommendations.
  
  
  RESULTS
  60 GP offices were randomly selected for study participation, however only 30 (50.0%) were willing to participate. 1,230 of 9,820 (12.52%) patients consented to the protocol. Quality of PBD spirometry was evaluated, and 882 (71.7%) met ATS/ERS quality criteria. 7.5% (95% CI: 5.7-9.4%) of the patients had COPD grade II+ (FEV1/FVC <0.7 and FEV1 <80% of predicted), but only 22.4% of them reported a prior physician's diagnosis of COPD. Similar results were seen for the 2005 Salzburg BOLD (Burden of Obstructive Lung Disease) sample with regard to COPD GOLD II+ prevalence (10.7%) and proportion of underdiagnosis (82.3%).
  
  
  CONCLUSIONS
  COPD in the primary-care setting is as prevalent and underdiagnosed as reported recently for the BOLD study. The surprisingly low participation rate of GPs and patients indicates that prevention of COPD is not a health priority, and that awareness for COPD has to heightened before case-finding strategies will be successful.
authors.affiliation: University Clinic of Pneumology, Salzburg, Austria.
authors.forename: Gertraud
authors.initials: G
authors.lastname: Weiss
authors.forename: Ina
authors.initials: I
authors.lastname: Steinacher
authors.forename: Bernd
authors.initials: B
authors.lastname: Lamprecht
authors.forename: Lea
authors.initials: L
authors.lastname: Schirnhofer
authors.forename: Bernhard
authors.initials: B
authors.lastname: Kaiser
authors.forename: Andreas
authors.initials: A
authors.lastname: Sönnichsen
authors.forename: Michael
authors.initials: M
authors.lastname: Studnicka
mesh_terms: D001317:Austria / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011320:Primary Health Care / Q000706:statistics & numerical data*; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis* / Q000453:epidemiology; D013147:Spirometry