Is generalization of exhaled CO assessment in primary care helpful for early diagnosis of COPD?

Nicolas Molinari; Mathieu Abou-Badra; Grégory Marin; Chin-Long Ky; Noemi Amador; Anne Sophie Gamez; Isabelle Vachier; Arnaud Bourdin

doi:10.1186/s12890-015-0039-6

Is generalization of exhaled CO assessment in primary care helpful for early diagnosis of COPD?

Nicolas Molinari ^{1, 2, *} Mathieu Abou-Badra ³ Grégory Marin ² Chin-Long Ky ⁴ Noemi Amador ² Anne Sophie Gamez ³ Isabelle Vachier ³ Arnaud Bourdin ^{1, 3}

* Auteur correspondant

1 PhyMedExp - Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046]

2 Département de l'Information Médicale

3 Service des Maladies Respiratoires [Montpellier]

4 EIO - Ecosystèmes Insulaires Océaniens (UMR 241)

Abstract : AbstractBackgroundCOPD is largely under-diagnosed and once diagnosed usually at a late stage. Early diagnosis is thoroughly recommended but most attempts failed as the disease is marginally known and screening marginally accepted. It is a rare cause of concern in primary care and spirometry is not very common. Exhaled carbon monoxide (eCO) is a 5-seconds easy-to-use device dedicated to monitor cigarette smoke consumption. We aimed to assess whether systematic eCO measurement in primary care is a useful tool to improve acceptance for early COPD diagnosis.MethodsThis was a two-center randomized controlled trial enrolling 410 patients between March and May, 2013. Whatever was the reason of attendance to the clinic, all adults were proposed to measure eCO 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.ResultsRate 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). eCO significantly increased the rate of clinics during which a debate on smoking was initiated (42 vs. 24%, P = 0.001). eCO at 2.5 ppm was the discriminative concentration for identifying active smokers (ROC curve AUC: 0.935). Smoking was the only independent risk factor associated with acceptance for early COPD screening (OR = 364.6 (82.5-901.5) and OR = 78.5 (18.7-330.0) in current and former smokers, respectively) while eCO measurement was not.ConclusionsEarly COPD diagnosis is a minor cause of concern in primary care. Systematic eCO assessment failed to improve acceptance for early COPD screening.

Keywords : Smoking Behaviour COPD Screening Exhaled CO

Type de document :

Article dans une revue

BMC Pulmonary Medicine, BioMed Central, 2015, 15 (1), pp.44. 〈10.1186/s12890-015-0039-6〉

Domaine :

Sciences du Vivant [q-bio]

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http://www.hal.inserm.fr/inserm-01259487
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Soumis le : mercredi 20 janvier 2016 - 15:03:39
Dernière modification le : jeudi 11 janvier 2018 - 06:27:49
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