title: Risk stratification for COPD diagnosis through an active search strategy in primary care.
abstract: BACKGROUND
  The aim of this study was to identify the percentage of undiagnosed patients with COPD through the implementation of an active search strategy in a selected subject population.
  
  
  METHODS
  An observational, cross-sectional, multicenter study was conducted in a primary care setting in Spain. General practitioners gave their diagnostic impression of COPD (yes/no) on the basis of clinical criteria of subjects with respiratory symptoms and tobacco exposure. Subsequently, post-bronchodilator spirometry and quality-of-life tests were performed. Multivariate logistic regression techniques using receiver operating characteristic (ROC) curves were used to identify the combination of variables that best discriminates COPD.
  
  
  RESULTS
  A total of 2,758 patients were screened at 368 primary care centers, of which 1,725 patients were included in the study. Seven hundred and ninety-three patients (46%) were diagnosed with COPD. Clinical judgment resulted in suspected COPD in 1,393 (81%) of the subjects. The best variables to discriminate COPD were a history of lower respiratory tract infections, cough, and dyspnea. This combination identified COPD with a ROCAUC of 0.61 denoting a poor discriminative ability.
  
  
  CONCLUSIONS
  Employing an active search strategy leads to a new COPD diagnosis in almost half of the subjects. Screening of COPD with post-bronchodilator spirometry should be considered mandatory for any high-risk subject visiting the general practitioner clinic for any reason.
authors.affiliation: Servicio de Neumología, Instituto de investigación Biomédica de A Coruña (INIBIC), Complejo Hospitalario Universitario de A Coruña (CHUAC), Sergas Universidade da Coruña (UDC), A Coruña, Spain.
authors.forename: Pedro J
authors.initials: PJ
authors.lastname: Marcos
authors.affiliation: Servicio de Neumología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain.
authors.forename: Rosa
authors.initials: R
authors.lastname: Malo de Molina
authors.affiliation: Medical Department, Novartis Farmacéutica SA, Barcelona, Spain.
authors.forename: Ricard
authors.initials: R
authors.lastname: Casamor
mesh_terms: D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D011320:Primary Health Care; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis* / Q000453:epidemiology; D018570:Risk Assessment
keywords: COPD; post-bronchodilator spirometry; primary care; screening