title: Implementation of a targeted screening program to detect airflow obstruction suggestive of chronic obstructive pulmonary disease within a presurgical screening clinic.
abstract: BACKGROUND
  Targeted spirometry screening for chronic obstructive pulmonary disease (COPD) has been studied in primary care and community settings. Limitations regarding availability and quality of testing remain. A targeted spirometry screening program was implemented within a presurgical screening (PSS) clinic to detect undiagnosed airways disease and identify patients with COPD/asthma in need of treatment optimization.
  
  
  OBJECTIVE
  The present quality assurance study evaluated airflow obstruction detection rates and examined characteristics of patients identified through the targeted screening program.
  
  
  METHODS
  The targeted spirometry screening program was implemented within the PSS clinic of a tertiary care university hospital. Current or ex-smokers with respiratory symptoms and patients with a history of COPD or asthma underwent prebronchodilator spirometry. History of airways disease and smoking status were obtained during the PSS assessment and confirmed through chart reviews.
  
  
  RESULTS
  After exclusions, the study sample included 449 current or ex-smokers. Abnormal spirometry results were found in 184 (41%) patients: 73 (16%) had mild, 93 (21%) had moderate and 18 (4%) had severe or very severe airflow obstruction. One hundred eighteen (26%) new cases of airflow obstruction suggestive of COPD were detected. One-half of these new cases had moderate or severe airflow obstruction. Only 34% of patients with abnormal spirometry results had reported a previous diagnosis of COPD. More than one-half of patients with abnormal spirometry results were current smokers.
  
  
  CONCLUSIONS
  Undiagnosed airflow obstruction was detected in a significant number of smokers and ex-smokers through a targeted screening program within a PSS clinic. These patients can be referred for early intervention and secondary preventive strategies.
authors.forename: Chantal
authors.initials: C
authors.lastname: Robitaille
authors.forename: Esther
authors.initials: E
authors.lastname: Dajczman
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Hirsch
authors.forename: David
authors.initials: D
authors.lastname: Small
authors.forename: Pierre
authors.initials: P
authors.lastname: Ernst
authors.forename: Dana
authors.initials: D
authors.lastname: Porubska
authors.forename: Mark
authors.initials: M
authors.lastname: Palayew
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001249:Asthma / Q000175:diagnosis* / Q000453:epidemiology; D015331:Cohort Studies; D003371:Cough / Q000175:diagnosis* / Q000453:epidemiology; D004417:Dyspnea / Q000175:diagnosis* / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods; D008875:Middle Aged; D011300:Preoperative Care / Q000379:methods*; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis* / Q000453:epidemiology; D011785:Quality Assurance, Health Care; D012720:Severity of Illness Index; D012907:Smoking / Q000453:epidemiology; D013147:Spirometry; D011795:Surveys and Questionnaires; D062606:Tertiary Care Centers