Researchers working with primary care patients in China have found that a simple questionnaire and airflow measurement test could identify adults with undiagnosed chronic obstructive pulmonary disease (COPD), a new study funded by National Institute for Health Research (NIHR).
COPD is a long-term illness characterized by persistent breathing problems. Almost a third of the 3.2 million annual deaths it causes worldwide come from China, where the disease is among the top three causes of death.
About 90 percent of the estimated 100 million sick people in China go undiagnosed. The study shows that the Chinese Symptom-Based Questionnaire (C-SBQ) combined with microspirometry – measuring how much air a patient can exhale in one forced breath – may provide the most effective way to identify patients requiring treatment for COPD.
An international research team, led by experts from the University of Birmingham, published their findings today in BMJ Open.
Co-author Professor Peymané Adab, Institute for Applied Health Research, University of Birmingham, commented: “COPD is a global killer and we are working with partners in China to improve ways to identify people with the disease who don’t realize it.
“COPD develops slowly, leading to delays in symptom recognition and high rates of underdiagnosis. Simple screening tests can help identify undiagnosed COPD within China’s primary care network – the first step in providing people with early treatment and potentially saving lives and reducing the burden on the country’s healthcare system. “
Study participants were recruited from an urban community health center (CSC) and a rural community health center in each of the four municipalities: Beijing, Chengdu, Guangzhou, and Shenyang. Residents aged 40 and over attending CHCs for any reason have been invited to participate.
Participants completed a study questionnaire covering demographics, smoking status, medical diagnoses, respiratory symptoms and quality of life, as well as a short baseline microspirometry test..
Participants with airway obstruction on the baseline test would be eligible for health education, smoking cessation counseling (if smokers), influenza vaccination, and inhalers, but the potential benefits of upgrading. full implementation and integration into an effective care pathway require further study.
Co-author Dr Rachel Jordan, Lecturer in Epidemiology and Primary Care at the University of Birmingham, commented: “Worsening symptoms of COPD is a common and costly complication, often associated with irreversible loss of lung function, hospitalization and death.
“Further work is needed to fully assess clinical efficacy and cost-effectiveness, but this simple combination of questionnaire and breath test is a promising and inexpensive option to be used across China to provide early diagnosis of COPD.
Although COPD screening programs are currently not approved in the US and UK, early identification is a priority in China. National policies recommend screening for undiagnosed COPD, but do not specify which screening tests to use. Although spirometry is required for clinical diagnosis, it is not widely available in primary care settings in China, and screening helps prioritize those who need a diagnostic referral.
The research was conducted as part of NIHR’s £ 2million Global Health Research Group on Global COPD in Primary Care and its Breathe Well Project.
Formed in June 2017, the Group has forged partnerships with teams in Brazil, China, Georgia and the Republic of North Macedonia and the International Primary Care Respiratory Group (IPCRG). This year, he will publish key research findings, based on projects in primary care settings assessing the accuracy of COPD screening strategies, promoting smoking cessation and improving disease management.
For more information, interviews or to request an embargoed copy of the research paper, please contact Tony Moran, International Communications Manager, University of Birmingham on +44 (0) 782 783 2312 or [email protected]. Outside opening hours, please call +44 (0) 7789 921 165.
Notes for Editors
- The University of Birmingham is ranked among the top 100 institutions in the world. Her work brings people from all over the world to Birmingham, including researchers, teachers and over 6,500 international students from over 150 countries.
- “Accuracy and cost-effectiveness of different screening strategies to identify undiagnosed COPD in primary care patients (??40 years) in China: a cross-sectional study on the accuracy of screening tests. Breathe Well Group results’ – Zihan Pan, Andrew P Dickens, Chunhua Chi Xia Kong, Alexandra Enocson, Brendan G Cooper, Peymané Adab, Kar Keung Cheng, Alice Sitch, Sue Jowett, Rachel Adams, Jaime Correia-de-Sousa, Amanda Farley, Nicola Gale, Kate Jolly, Mariam Maglakelidze , Tamaz Maglakelidze, Sonia M Martins, Katarina Stavrikj, Rafael Stelmach, Alice M Turner, Siân Williams and Rachel E Jordan is published in BMJ Open.
- The mission of the National Institute for Health Research (NIHR) is to improve the health and wealth of the nation through research. We do this by:
Fund high quality and timely research that benefits the NHS, public health and social services;
Invest in world-class expertise, facilities and a skilled workforce to translate findings into improved treatments and services;
Collaborate with patients, service users, caregivers and communities, improving the relevance, quality and impact of our research;
Attract, train and support the best researchers to tackle complex challenges in health and social care;
Collaborate with other public funders, charities and industry to help shape a cohesive and globally competitive research system;
Funding for applied research and training in global health to meet the needs of the poorest people in low- and middle-income countries.
NIHR is funded by the Department of Health and Social Affairs. Its work in low and middle income countries is primarily funded by UK Aid from the UK government.
The title of the article
Accuracy and Cost-Effectiveness of Different Screening Strategies for Identifying Undiagnosed COPD in Primary Care Patients (≥ 40 Years of Age) in China: A Cross-sectional Precision Study of Screening Tests. Results of the Breathe Well group
Publication date of the article
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