A new study, entitled “TargetCOPD: a pragmatic randomized controlled trial of targeted case finding for COPD versus routine practice in primary care: protocol” recently published in BMC Pulmonary Medicine by Dr. Rachel E. Jordan and colleagues from the School of Health and Population Sciences, University of Birmingham, Birmingham, UK, outlines a plan to identify undiagnosed patients with COPD in the UK and other similar healthcare systems to allow for effective treatment options.
Chronic obstructive pulmonary disease (COPD) is used to designate a group of lung diseases like chronic bronchitis, emphysema and chronic obstructive airways disease. COPD is a common preventable and treatable respiratory condition, but is a major cause of morbidity and mortality in the world. While COPD diagnosed cases are predict to be 1.3% of the population, it’s known that 50-80% of patients with clinically significant disease are not diagnosed and thus not effectively treated, therefore in UK and other countries the identification these patients is a priority.
This study design is a cluster randomized controlled trial (RCT) (ISRCTN14930255) in 56 general practices in the West Midlands, with patients between 40 and 79 years who are current or ex-smokers without a diagnosis of COPD and registered with participating practices. The aim of the study was to investigate the effectiveness and cost-effectiveness of a Targeted approach to case finding for COPD compared with routine practice, over the next three years. In addition, the researchers will use an individual patient RCT nested in the targeted arm to compare the effectiveness and cost-effectiveness of active case finding using a postal questionnaire, and opportunistic case finding at usual surgery consultations.
Patients in the Targeted arm who show positive respiratory symptoms (chronic cough or phlegm, wheeze or dyspnoea) through a brief questionnaire will be included to perform a spirometric assessment to confirm or not the COPD diagnosis. Post-bronchodilator spirometry will be conducted to ATS standards using an Easy One spirometer by trained research assistants. The researchers will compare which method is the most effective and cost-effective in identifying new patients, possibly allowing earlier treatment. We will also explore patients’ views on this process by inviting some patients for face to face interviews.
This is the largest cluster randomized controlled trial of this type ever done and will help local policy-makers to prioritize, decide and deliver treatment to the sub-groups of the population analyzed.