title: The impact of screening tools on diagnosis of chronic obstructive pulmonary disease in primary care.
abstract: BACKGROUND
  Chronic obstructive pulmonary disease (COPD) is frequently misdiagnosed or undiagnosed, which can delay disease management interventions.
  
  
  OBJECTIVE
  The Screening, Evaluating and Assessing Rate CHanges of diagnosing respiratory conditions in primary care 1 (SEARCH1) study assessed whether screening using the COPD Population Screener (COPD-PS) questionnaire to detect COPD risk factors and symptoms, with or without a handheld spirometer (copd-6) to detect airflow limitation, can increase yields of COPD diagnosis and respiratory-related clinician actions in primary care.
  
  
  METHODS
  A prospective, multi-center, pragmatic, comparative-effectiveness, cluster-randomized study conducted from September 2010 to October 2011 (data analyzed from December 2011 to January 2013).
  
  
  METHODS
  Men and women aged ≥40 years visiting their participating primary care practice for any reason.
  
  
  METHODS
  Practices were randomized to three study arms: COPD-PS + copd-6, COPD-PS alone, and usual care (no interventions). No practices received any specific education about COPD or its diagnosis.
  
  
  METHODS
  The primary endpoint was yield of new clinical COPD diagnosis; the secondary endpoint was yield of respiratory-related clinician actions.
  
  
  RESULTS
  Of 9,704 patients enrolled, 8,770 had no prior COPD diagnosis and were included in endpoint analyses. Both interventions significantly increased COPD diagnostic yield over 8 weeks. Compared with a mean yield of 0.49% (0.13%) (controls), yields were 1.07% (0.20%) (OR=2.20, 95% CI=1.26, 3.84, p=0.006) and 1.16% (0.22%) (OR=2.38, 95% CI=1.38, 4.13, p=0.002) for COPD-PS and COPD-PS+copd-6 study arms, respectively. Respiratory-related clinician actions were not significantly different across study arms.
  
  
  CONCLUSIONS
  Office-based assessment can significantly increase COPD diagnosis by primary care physicians. Future trials must evaluate whether screening can improve outcomes for patients with COPD.
authors.affiliation: Department of Research, Olmsted Medical Center, Rochester, Minnesota. Electronic address: byawn@olmmed.org.
authors.forename: Barbara P
authors.initials: BP
authors.lastname: Yawn
authors.affiliation: Department of Family Medicine, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California.
authors.forename: Karen
authors.initials: K
authors.lastname: Duvall
authors.affiliation: QURE Healthcare, San Rafael, California, Glaxo SmithKline (Albers), Chapel Hill, North Carolina.
authors.forename: John
authors.initials: J
authors.lastname: Peabody
authors.affiliation: Department of Research, Olmsted Medical Center, Rochester, Minnesota.
authors.forename: Frank
authors.initials: F
authors.lastname: Albers
authors.affiliation: Pfizer, Inc. (Iqbal), New York, New York.
authors.forename: Ahmar
authors.initials: A
authors.lastname: Iqbal
authors.affiliation: Boehringer Ingelheim Pharmaceuticals, Inc., Ridgefield, Connecticut.
authors.forename: Heather
authors.initials: H
authors.lastname: Paden
authors.affiliation: Boehringer Ingelheim Pharmaceuticals, Inc., Ridgefield, Connecticut.
authors.forename: Valentina B
authors.initials: VB
authors.lastname: Zubek
authors.affiliation: Department of Family Medicine, Michigan State University, East Lansing, Michigan.
authors.forename: William C
authors.initials: WC
authors.lastname: Wadland
mesh_terms: D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods; D008875:Middle Aged; D011320:Primary Health Care / Q000379:methods* / Q000706:statistics & numerical data; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis*; D012307:Risk Factors; D013147:Spirometry; D011795:Surveys and Questionnaires