title: Office-Based Case Finding for Chronic Obstructive Pulmonary Disease in Older Adults in Primary Care.
abstract: Background. Chronic Obstructive Pulmonary Disease (COPD) is underdiagnosed in primary care. Aim. To explore the utility of proactive identification of COPD in patients 75 years of age and older in a Canadian primary care setting. Methods. Canadian Thoracic Society (CTS) screening questions were administered to patients with a smoking history of 20 pack-years or more; those with a positive screen were referred for postbronchodilator spirometry. Results. A total of 107 patients (21%), of 499 screened, had a 20-pack-year smoking history; 105 patients completed the CTS screening. Forty-four (42%) patients were positive on one or more questions on the screening; significantly more patients with a previous diagnosis of COPD (64%) were positive on the CTS compared to those without a previous diagnosis of COPD (30%). Of those who were not previously diagnosed with COPD (N = 11), four (36%) were newly diagnosed with COPD. Conclusion. A systematic two-stage method of screening for COPD, using CTS screening questions followed by spirometric confirmation, is feasible in the context of a busy primary care setting. More research is needed to assess the value of restricting screening to patients with a smoking history of 20 pack-years and on the sensitivity and specificity of these measures.
authors.affiliation: Centre for Family Medicine Family Health Team, 10B Victoria Street South, Kitchener, ON, Canada N2G 1C5; Department of Family Medicine, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada; Schlegel-University of Waterloo Research Institute for Aging, Waterloo, ON, Canada.
authors.forename: Linda
authors.initials: L
authors.lastname: Lee
authors.affiliation: Centre for Family Medicine Family Health Team, 10B Victoria Street South, Kitchener, ON, Canada N2G 1C5; Department of Family Medicine, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada; University of Waterloo School of Pharmacy, Waterloo, ON, Canada.
authors.forename: Tejal
authors.identifier: 0000-0003-3002-8306
authors.initials: T
authors.lastname: Patel
authors.affiliation: St. Joseph's Health Care, London, ON, Canada; Aging, Rehabilitation and Geriatric Care Research Centre of the Lawson Health Research Institute, London, ON, Canada.
authors.forename: Loretta M
authors.identifier: 0000-0002-8036-6664
authors.initials: LM
authors.lastname: Hillier
authors.affiliation: Centre for Family Medicine Family Health Team, 10B Victoria Street South, Kitchener, ON, Canada N2G 1C5; Department of Family Medicine, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada; Schlegel-University of Waterloo Research Institute for Aging, Waterloo, ON, Canada.
authors.forename: James
authors.identifier: 0000-0003-3387-1614
authors.initials: J
authors.lastname: Milligan
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods*; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis*; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012189:Retrospective Studies