title: COPD detected with screening: impact on patient management and prognosis.
abstract: It is uncertain whether screening of older persons for chronic obstructive pulmonary disease (COPD) is worthwhile because the effects on patient management and prognosis are unknown. We aimed to assess the short-term consequences of detecting COPD in frail elderly subjects with dyspnoea, considering pulmonary drug use, hospitalisations and all-cause mortality. Community-dwelling frail elderly subjects, aged 65 years and older, with dyspnoea, participating in a screening study on COPD and heart failure were included. Final diagnoses were assigned by an expert panel based on all data from the screening strategy, including spirometry. Follow-up data were collected from the general practitioners. Of the 386 patients, 84 (21.8%) were received a new diagnosis of COPD. Overall, changes in pulmonary drug prescription during 6 months of follow-up were infrequent (n = 53, 13.7%; among new cases of COPD, 15 (17.9%) out of 84). Of all participants, 25.9% were hospitalised in the first year of follow-up, with the highest rate in patients with newly detected COPD (32.1%). Many new cases of COPD could be detected by screening frail elderly subjects with dyspnoea, but the impact on patient management seems limited. Our study underlines the importance of obtaining follow-up data to assess the true impact of a (screen-detected) diagnosis of COPD on patient management and outcome.
authors.affiliation: Julius Center for Health Sciences and Primary care, University Medical Center Utrecht, Utrecht, the Netherlands L.C.M.Bertens-2@umcutrecht.nl.
authors.forename: Loes C M
authors.initials: LC
authors.lastname: Bertens
authors.affiliation: Julius Center for Health Sciences and Primary care, University Medical Center Utrecht, Utrecht, the Netherlands.
authors.forename: Johannes B
authors.initials: JB
authors.lastname: Reitsma
authors.affiliation: Julius Center for Health Sciences and Primary care, University Medical Center Utrecht, Utrecht, the Netherlands.
authors.forename: Yvonne
authors.initials: Y
authors.lastname: van Mourik
authors.affiliation: Dept of Pulmonology, Division of Heart and Lungs, University Medical Center Utrecht, Utrecht, the Netherlands.
authors.forename: Jan-Willem J
authors.initials: JW
authors.lastname: Lammers
authors.affiliation: Julius Center for Health Sciences and Primary care, University Medical Center Utrecht, Utrecht, the Netherlands.
authors.forename: Karel G M
authors.initials: KG
authors.lastname: Moons
authors.affiliation: Julius Center for Health Sciences and Primary care, University Medical Center Utrecht, Utrecht, the Netherlands.
authors.forename: Arno W
authors.initials: AW
authors.lastname: Hoes
authors.affiliation: Julius Center for Health Sciences and Primary care, University Medical Center Utrecht, Utrecht, the Netherlands.
authors.forename: Frans H
authors.initials: FH
authors.lastname: Rutten
mesh_terms: D000318:Adrenergic beta-Agonists / Q000627:therapeutic use*; D000368:Aged; D000369:Aged, 80 and over; D018680:Cholinergic Antagonists / Q000627:therapeutic use*; D004417:Dyspnea / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology; D017079:Exercise Tolerance; D005260:Female; D016330:Frail Elderly; D005938:Glucocorticoids / Q000627:therapeutic use*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008403:Mass Screening; D011379:Prognosis; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D013147:Spirometry
chemical_list: D000318:Adrenergic beta-Agonists; D018680:Cholinergic Antagonists; D005938:Glucocorticoids