More than one in five smokers and former smokers suffer from chronic obstructive pulmonary disorder, but two-thirds of them don't even know it, research shows.
“These dramatic results show that more screening needs to be done at the primary-care level,” said Roger Goldstein
He said that while under-diagnosis of COPD in the general population has been well catalogued, the new findings are especially troubling because they focus on relatively heavy smokers, many of whom have fairly obvious symptoms.
“A visit to a family doctor or any health centre is the perfect time to identify at-risk people for testing for COPD,” Dr. Goldstein said.
The research, published in today's edition of the Canadian Medical Association Journal, involved 1,003 adults over the age of 40 who had visited a family physician in three Ontario cities – Ottawa, Toronto and Sault Ste. Marie.
All of them were smokers or former smokers who had consumed at least 20 pack-years of cigarettes. (A pack-year is the number of packs smoked per day, multiplied by the number of years smoked; a four pack-a-day smoker for five years is equivalent to a one-pack a day smoker for 20 years.)
All the study participants underwent spirometry, a standard breathing test, and answered a questionnaire.
Researchers diagnosed 208 of those tested as having COPD – 20.7 per cent. But they found only 67 – 32.7 per cent – had been diagnosed previously.
Dr. Goldstein said virtually all the undiagnosed patients had at least two common risk factors and symptoms of COPD. These include a history of smoking, shortness of breath and chronic coughing and/or wheezing.
In fact, half of those who were undiagnosed were current smokers.
Canadian Thoracic Society guidelines recommend spirometry for everyone over 40 who smokes, or has smoked, and has a symptom such as breathlessness, wheezing, cough or persistent phlegm.
The reason testing is not done routinely, Dr. Goldstein said, is that there are many myths about COPD, principally that it is untreatable. “People with COPD are breathless but not helpless,” he said. There are medications to treat the condition and rehabilitation programs that help patients learn breathing and exercise techniques that can improve their breathing.
Research published earlier this year found that the number of adults living with COPD has soared by 65 per cent in the past decade. In the same period, though, the death rate has fallen by 25 per cent because of earlier diagnosis and improved treatments.
COPD includes a variety of conditions, such as emphysema and bronchitis; it is characterized by blocked lungs and restricted air flow. The condition places sufferers at high risk for common respiratory infections like influenza and can lead to blood-clotting problems that trigger heart attacks and strokes.
Patients use a variety of treatments, including bronchodilators (commonly known as puffers) to treat shortness of breath; corticosteroids to prevent flare-ups of breathing problems and antibiotics to treat infections that can stress breathing. Vaccines against influenza and pneumococcal disease have also lowered the death rate, and the portability of oxygen tanks has made it easier for people with severe COPD to lead normal lives.
By far the most common underlying cause of COPD is smoking, but environmental factors such as pollution also contribute.
An estimated three million Canadians suffer from chronic obstructive pulmonary disease. COPD treatment costs the health-care system at least $1.5-billion annually, according to the Canadian Thoracic Society.
