Simple, low cost tests could help China's battle to identify COPD sufferers

An illustration of lungs in the body.
Chronic obstructive pulmonary disease is a long-term condition characterised by persistent breathing problem.

Researchers working with primary care patients in China have discovered that a simple questionnaire and airflow measurement test could identify adults suffering with undiagnosed chronic obstructive pulmonary disease (COPD), a new study funded by the National Institute for Health Research (NIHR) reveals.

COPD is a long-term condition characterised by persistent breathing problems. Nearly one-third of the 3.2 million annual global deaths it causes are from China, where the disease ranks among the top three leading causes of death.

Some 90% of the estimated 100 million sufferers in China are undiagnosed. The study shows the Chinese symptom-based questionnaire (C-SBQ) combined with microspirometry – measuring how much air a patient can breathe out in one forced breath – could provide the most efficient way of identifying patients needing treatment for COPD.

An international research team, led by experts at the University of Birmingham, have published their findings in BMJ Open.

Co-author Professor Peymané Adab, from the University of Birmingham’s Institute of Applied Health Research, commented: “COPD is a global killer and we’re working with partners in China to improve ways of identifying those people who have the disease, but don’t realise it.

“COPD develops slowly, resulting in 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 one urban and one rural community health centre (CHC) in each of four municipalities: Beijing, Chengdu, Guangzhou and Shenyang. Residents aged 40 years and above attending CHCs for any reason were invited to participate.

Those taking part completed a study questionnaire covering demographics, smoking status, medical diagnoses, respiratory symptoms and quality of life, as well as taking a short microspirometry reference test.

Participants with airflow obstruction on the reference test would be eligible for health education, smoking cessation advice (if smokers), influenza vaccination and inhalers but the potential benefits of full implementation and integration into an effective care pathway need further study.

Co-author Dr Rachel Jordan, Reader in Epidemiology and Primary Care at the University of Birmingham, commented: “Worsening of COPD symptoms is a common and costly complication, often associated with irreversible loss of lung function, hospitalisation and death.

“Further work is needed to fully assess clinical efficiency and cost-effectiveness, but this simple combination of questionnaire and breathing test is a promising, low cost option to be used across China to provide early diagnosis of COPD.”

While COPD screening programmes are not currently endorsed in the US and UK, early identification is being prioritised 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 prioritise those who need diagnostic referral.

The research was carried out as part of the £2 million NIHR Global Health Research Group on Global COPD in Primary Care and its Breathe Well project.

Formed in June 2017, the Group has established partnerships with teams in Brazil, China, Georgia and Republic of North Macedonia and the International Primary Care Respiratory Group (IPCRG). It will publish key research findings this year, based on projects in primary care settings evaluating accuracy of COPD screening strategies, promoting smoking cessation and improving disease management.

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