Systematic eCO Assessment Does Not Improve Acceptance for Early COPD Screening

Systematic eCO Assessment Does Not Improve Acceptance for Early COPD Screening

In a recent study titled “Is generalization of exhaled CO assessment in primary care helpful for early diagnosis of COPD? a research team from the Département de l’Information Médicale. Hôpital La Colombière in Montpellier, France found that early Chronic obstructive pulmonary disease (COPD) diagnosis is a minor cause of concern in primary care. Results from the study also indicate that systematic eCO assessment does not improve acceptance for early COPD screening. The study is published in the journal BMC Pulmonary Medicine.

Estimates indicate that Chronic obstructive pulmonary disease (COPD) will be the fourth leading cause of death by 2030. Underdiagnosis of COPD is a global problem, delaying adequate treatment and the possibility of preventing physical, emotional and socioeconomic consequences of the disease. Early detection of COPD is crucial for promoting smoking cessation – which is the unique way to interfere with the natural history of the disease.

Assessing exhaled carbon monoxide (eCO) concentration is routinely used in tobacco weaning programs for up to fifteen years, and it is a valuable noninvasive biomarker of cigarette smoke daily consumption. As it stands, eCO is a 5- or 10-second measurement that responds to most issues related to any tool: easy to conduct, no contraindication, no expertise requirement, absolute harmlessness, and low cost.

Since cigarette smoking remains the main cause of COPD in western countries, the researchers hypothesized that assessing eCO in primary care could help GPs to improve awareness about COPD that will introduce acceptance for a COPD screening.

The researchers also assumed that eCO assessment in waiting rooms would improve the debate on smoking and COPD during medical consultations. In a two-center randomized controlled trial the researchers enrolled 410 patients. All patients’ adults had eCO measured during randomly chosen days and outcomes were compared between the two different groups of patients (performing and not performing eCO). Primary outcome was the rates of acceptance for COPD screening.

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Results revealed that the rate of acceptance for COPD screening was 28% in the eCO group and 26% in the other (P =0.575). These rates increased to 48 and 51% in smokers (current and former). The researchers also determined that smoking was the only independent risk factor associated with acceptance for early COPD screening in current and former smokers, while eCO measurement was not.

Based on the results, the researchers concluded that generalized eCO measurement in general practice failed to improve acceptance for early COPD screening. In the study the investigators indicate the need for larger studies using a comparative historical period in the future to help combat the continued increase in COPD prevalence.


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