Municipality screening of citizens with suspicion of chronic obstructive pulmonary disease

Tina Riegels-Jakobsen¹, Malene Skouboe¹, Jens Dollerup², Christian Buus Andersen², Louise Barkan Staal¹, Rolf BH Jakobsen¹, Peter Bo Poulsen^2
1Department of Health Prevention and Promotion, Municipality of Esbjerg, Esbjerg, ²Medical and Access, Pfizer Denmark, Ballerup, Denmark

Abstract: Up to 436,000 adult Danes suffer from chronic obstructive pulmonary disease (COPD), with only one third diagnosed at this time. The Danish National Board of Health recommends early detection of COPD, focusing on smokers/ex-smokers over 35 years of age with at least one lung symptom. A governmental prevention committee has suggested that the municipalities, in addition to general practice, should be a potential arena responsible for early detection of COPD. We undertook a pilot study to investigate the feasibility and effectiveness of early detection of COPD in municipalities following the recommendations of the Danish National Board of Health.
Methods: The Municipality of Esbjerg offered spirometry to Danish citizens at risk of COPD without a previous diagnosis of the disease, following the National Board of Health's recommendations. Citizens with evidence of airway obstruction (forced expiratory volume in one second [FEV₁]/forced vital capacity [FVC] <70%) were advised to visit their general practitioner for diagnosis. These citizens were followed up by telephone interview 3 months later.
Results: Of 152 citizens sampled (50% females, mean age 58 years, 51% smokers) 51.3% had evidence of airway obstruction, with 87% being mild to moderate in terms of severity. Seven of ten citizens (71%) then visited their general practitioner, with 85% of these being diagnosed with COPD. The number of smokers embarking on smoking cessation or quitting smoking increased following COPD screening, with the highest frequency in participants with evidence of airway obstruction.
Conclusion: In addition to early detection of COPD in general practice, early detection of airway obstruction in defined risk populations in Danish municipalities seems feasible and effective for identifying new patients with COPD. However, additional research is needed in larger samples to confirm the results of the present study.

Keywords: chronic obstructive pulmonary disease, screening, spirometry, smoking cessation