Targetted Screening Of Chronic Obstructive Pulmonary Disease In French Primary Care : The Disco Study

Background: Chronic Obstructive Pulmonary Disease (COPD) is the third leading cause of death worldwide in 2020. In France 75% of COPD patients are undiagnosed because of the insidious onset of the disease and difficulty in accessing spirometry. Aims and Objectives: evaluate a coordinated primary care organization for early detection of new diagnoses of COPD. Methods: This multi-center, randomized, controlled cluster study compared two detection strategies in a 2x2 factoriel design. Patients in arm 1 (control) were included by general practitioner (GP) uninformed of the disease detected. A questionnaire identifying the "at-risk" patients by the GP (arm 2). A coordination of the patient9s path to facilitate access to spirometry by medical assistant (arm 3). Arm 4 combined the two strategies. Included were all between 40-80 years old, without known COPD, consulting their GP for any reason. The primary endpoint was the number of COPD in each arm of the study. Results: 3162 patients were included by 47 GPs. Patients identified at risk of COPD were reffered to spirometry in 0%, 29.5%, 50.0% and 72.7% respectively in arms 1 to 4. The percentage of new COPD diagnoses was 0% (control arm) and 0.6 to 1.2% in arms 1 to 4, with the benefit of coordination (p=0.0053) Conclusions: The existence of the control group and the large number of patients included is the study9s strength. The main limitation was that more than half of the patients did not perform the prescribed spirometry. We observe an increase in the rate of COPD between 0.6 and 1.2%, comparable to the literature. This simple strategy is compatible with French MG exercise, coordinate the care path is efficient to detect new cases of COPD.