Detection of COPD in Primary Care (DISCO)

Rennes University Hospital

Status: Completed

Conditions: Chronic Obstructive Pulmonary Disease

Treatments: Other: Questionnaire; Other: Coordination

Study type: Interventional

Funder types: Other

Identifiers

NCT03046199

35RC16_9770_DISCO

Details and patient eligibility

About

Chronic obstructive pulmonary disease (COPD) is a common chronic disease with a significant medical and economic impact. Its prevalence is increasing and is estimated at 7.5% of people over 40 in France. COPD is responsible for a significant impairment of quality of life and was the 3rd leading cause of death in the world in 2010 when it was 4th place 20 years ago.

However, about 75% of patients with COPD are not diagnosed. Spirometry is the only examination for the diagnosis of COPD. Patients identified at risk for COPD are insufficiently using spirometry and general practitioners (GPs) underestimate the severity of COPD when they do not practice spirometry in their patients. COPD is often diagnosed too late, the disease being discovered at the stage of complications requiring hospitalization. The underdiagnosis is mainly due to poor knowledge of patients, their difficulty in accessing a specialist performing spirometry, their reluctance to perform spirometry, and the insufficient involvement of general practitioners.

Currently in France, targeted screening for COPD and diagnosis in primary care is a major challenge. The international (GOLD 2014) and French (HAS 2014) recommendations do not indicate a systematic screening in the general population for COPD but advocate targeted screening of patients by five questions to identify risk factors and symptoms of COPD. The presence of at least one of these factors in an adult over the age of 40 requires spirometry.

Recent studies suggest the relevance of finding primary care variables for smoking and respiratory symptoms in order to identify new cases of COPD.

However, the impact of the use of these questionnaires on the prevalence of diagnoses of COPD in general practice has not been demonstrated. Moreover, the heterogeneity of the provision of care according to the territories limits a fast or easy access (distance) to the spirometry.

It is therefore necessary to evaluate in primary care the interest of a targeted screening of COPD and the interest of a coordination of care for the realization of a spirometry, in order to improve the rate of diagnosis of the disease.

Enrollment: 3,162 patients

Sex: All

Ages: 40 to 80 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Patients with health insurance
• Non-opposition to participation in the study

Exclusion criteria

• COPD known and confirmed by spirometry
• Asthma known and confirmed by spirometry
• Patient not having the physical or mental ability to perform spirometry
• Pregnant woman
• Patient under protection
• Patient already included in the study

Trial design

Primary purpose: Screening

Allocation: Randomized

Interventional model: Factorial Assignment

Masking: None (Open label)

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3,162 participants in 4 patient groups

Control

No Intervention group

Questionnaire

Experimental group

Treatment:

Other: Questionnaire

Coordination

Experimental group

Treatment:

Other: Coordination

Questionnaire + coordination

Experimental group

Treatment:

Other: Coordination

Other: Questionnaire