title: Identifying Patients with Undiagnosed COPD in Primary Care Settings: Insight from Screening Tools and Epidemiologic Studies.
abstract: OBJECTIVE
  Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality, yet research suggests this disease is greatly underdiagnosed. This literature review sought to summarize the most common and significant variables associated with case-finding or missed cases of COPD to inform more effective and efficient detection of high-risk COPD patients in primary care.
  
  
  METHODS
  PubMed and EMBASE were searched for articles describing case-finding and epidemiologic research to detect or characterize new cases of COPD. International studies in primary and non-primary care settings, published in English from 2002-2014, were eligible for inclusion. Studies related to risk factors for development of COPD were excluded.
  
  
  RESULTS
  Of the 33 studies identified and reviewed, 21 were case-finding or screening and 12 were epidemiological, including cross-sectional, longitudinal, and retrospective designs. A range of variables were identified within and across studies. Variables common to both screening and epidemiological studies included age, smoking status, and respiratory symptoms. Seven significant predictors from epidemiologic studies did not appear in screening tools. No studies targeted discovery of higher risk patients such as those with reduced lung function or risks for exacerbations.
  
  
  CONCLUSIONS
  Variables used to identify new cases of COPD or differentiate COPD cases and non-cases are wide- ranging, (from sociodemographic to self-reported health or health history variables), providing insight into important factors for case identification. Further research is underway to develop and test the best, smallest variable set that can be used as a screening tool to identify people with undiagnosed, high-risk COPD in primary care.
authors.affiliation: University of Michigan, Ann Arbor.
authors.forename: MeiLan K
authors.initials: MK
authors.lastname: Han
authors.affiliation: Evidera, Bethesda, Maryland.
authors.forename: Anna W
authors.initials: AW
authors.lastname: Steenrod
authors.affiliation: Evidera, Bethesda, Maryland.
authors.forename: Elizabeth D
authors.initials: ED
authors.lastname: Bacci
authors.affiliation: Evidera, Bethesda, Maryland.
authors.forename: Nancy K
authors.initials: NK
authors.lastname: Leidy
authors.affiliation: University of Kentucky, Lexington.
authors.forename: David M
authors.initials: DM
authors.lastname: Mannino
authors.affiliation: Columbia University, New York, New York.
authors.forename: Byron M
authors.initials: BM
authors.lastname: Thomashow
authors.affiliation: Columbia University, New York, New York.
authors.forename: R G
authors.initials: RG
authors.lastname: Barr
authors.affiliation: National Jewish Health, Denver, Colorado.
authors.forename: Barry J
authors.initials: BJ
authors.lastname: Make
authors.affiliation: National Jewish Health, Denver, Colorado.
authors.forename: Russ P
authors.initials: RP
authors.lastname: Bowler
authors.affiliation: University of Nebraska, Omaha.
authors.forename: Stephen I
authors.initials: SI
authors.lastname: Rennard
authors.affiliation: University of Nebraska, Omaha.
authors.forename: Julia F
authors.initials: JF
authors.lastname: Houfek
authors.affiliation: Olmsted Medical Center, Rochester, Minnesota.
authors.forename: Barbara P
authors.initials: BP
authors.lastname: Yawn
authors.affiliation: University of Michigan, Ann Arbor.
authors.forename: Catherine A
authors.initials: CA
authors.lastname: Meldrum
authors.affiliation: COPD Foundation, Washington, DC.
authors.forename: John W
authors.initials: JW
authors.lastname: Walsh
authors.affiliation: Weill Cornell Medical Center, New York, New York.
authors.forename: Fernando J
authors.initials: FJ
authors.lastname: Martinez
keywords: chronic obstructive pulmonary disease; literature review; primary care; screening