A team led by researchers at Centre Hospitalier Régional Universitaire de Montpellier and University of Montpellier in France revealed that an early diagnosis of chronic obstructive pulmonary disease (COPD) is halted by a lack of concern, awareness and simple diagnostic tools in primary care. The study is entitled “Is generalization of exhaled CO assessment in primary care helpful for early diagnosis of COPD?” and was recently published in the journal BMC Pulmonary Medicine.

COPD is one of the most common lung diseases and a major cause of morbidity and mortality worldwide, and is the third leading cause of death in the United States. It is a progressive disease in which individuals develop serious breathing problems such as obstruction of the airways, shortness of breath (dyspnea) and acute exacerbations.

COPD is often under-diagnosed in primary care units being frequently diagnosed only at a late disease stage. Although an early COPD diagnosis is recommended, the disease is still a minor cause of concern in primary care and diagnostic tests such as spirometry to assess lung function are not commonly performed. The reasons why clinicians don’t perform spirometry have been suggested to be linked to limited access to the equipment, time constraints or lack of adequate training.

Exhaled carbon monoxide (eCO) is an easy, user-friendly, harmless, rapid (5 to 10 seconds) and low-cost test routinely used to monitor cigarette smoke consumption in tobacco weaning programs. As smoking is the leading cause of COPD, smoking cessation is considered the most relevant strategy to interfere with the disease course.

In this study, researchers hypothesized that systematic eCO measurement in primary care could be a valuable tool to improve COPD awareness and help introduce acceptance for a COPD screening. Researchers conducted a two-center, randomized controlled trial between March and May, 2013 involving 410 adult patients who attended the two primary care centers. Of these patients, 216 were submitted to eCO measurement and the rate of acceptance for COPD screening was compared between patients who performed eCO and patients who didn’t.

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The team found that 28% of the patients submitted to eCO measurement accepted COPD screening, while a similar rate (26%) was obtained in patients who had not performed the eCO test. Nonetheless, eCO was found to increase the debate among patients concerning smoking consequences and COPD, especially among smokers. Smoking was the only independent risk factor found to be linked with the rate of COPD screening acceptance, whereas eCO was not.

The research team concluded that eCO measurement in medical primary care failed to promote patients acceptance for early COPD screening. Larger studies are, however, required to definitely conclude whether eCO can or not be a useful tool for COPD screening acceptance. The team believes that there is an urgent need to share information regarding COPD among the general population and clinicians, and that more efforts should be made to reach this goal.