Cornell University’s leads study on continuing challenge of screening for COPD

A new screening tool identified roughly half of primary care patients with chronic obstructive pulmonary disorder (COPD) who could benefit from available treatments, according to a nationwide study.

The research was led by investigators at Weill Cornell Medicine; NewYork-Presbyterian; the University of Michigan, Ann Arbor; National Jewish Health; the University of Minnesota and their colleagues. This performance – which they evaluated as a part of a larger, still-unfinished project – indicates that further research is needed to optimize the tool.

For the study, which is described Feb. 14 in JAMA, patients received a COPD screening tool known as CAPTURE. The screening relies on five questions and, potentially, a simple measure of lung function frequently performed in primary care, which generate a score that determines if the patient should also receive a subsequent breathing test and clinical evaluation. Researchers compared these results to those obtained when they complete a more definitive lung function test known as spirometry, the gold standard for diagnosing COPD.

Of the 4,325 undiagnosed patients included in the analysis, spirometry identified 110 with clinically significant COPD. CAPTURE flagged 53 of these cases.

“We found that CAPTURE does pick up these people, but not all of them,” said co-senior author Dr. Fernando Martinez, the Bruce Webster Professor of Internal Medicine at Weill Cornell Medicine and chief of the Division of Pulmonary and Critical Care Medicine at Weill Cornell Medicine and NewYork-Presbyterian/Weill Cornell Medical Center.

More than decade ago, Martinez was part of a team that developed CAPTURE to help physicians readily identify those at risk. However, while the screen’s performance was good at finding those with COPD, CAPTURE also identified a large group of patients with breathing symptoms and abnormalities that didn’t rise to the level of COPD.

“It also picks up many other problems that we didn’t realize were so prevalent in primary care,” he said.

“Additional studies are needed to evaluate how CAPTURE impacts patient health outcomes, but the tool shows early effectiveness for detecting people who have more severe cases of obstructed airflow, asthma and a history of respiratory illness,” said James P. Kiley, director of National Heart, Lung, and Blood Institute’s Division of Lung Diseases. “By conducting additional testing for these patients, primary care physicians can get closer to providing more adults with undiagnosed COPD with appropriate treatment and care.”

COPD encompasses a group of conditions, including emphysema and chronic bronchitis, that interfere with breathing. Collectively, they affect nearly 5% of the global population, according to an analysis of the global burden of disease. In the United States, COPD is the largest contributor to a leading cause of death: chronic lower respiratory diseases.

Even so, experts believe COPD often goes undiagnosed, in part because spirometry is not widely available.

“Unfortunately, many patients with COPD go undiagnosed and are often not picked up until their disease is quite advanced. As treatments for COPD improve, we have increasing ability to prevent morbidity and mortality among COPD patients,” said Dr. MeiLan Han, co-principal investigator on the study and chief of the Division of Pulmonary and Critical Care at the University of Michigan. “That’s why studies such as CAPTURE are so important to identify patients in primary care who would benefit from treatment.”

For the study, researchers focused on clinically significant COPD – that is, cases severe enough to need treatment. They enrolled participants between the ages of 45 and 80 who had not previously been diagnosed with COPD. The research, which took place at 100 primary care sites across the country, enrolled patients in primary care between 2018 and 2022.

The analysis also suggested that breathing issues in general were relatively common among these patients. Of the 4,325 participants, CAPTURE identified 532 whose questionnaire and breathing test scores indicated problems ranging from clinically significant COPD to other respiratory difficulties.

“One of the key findings in this study is that patients often have chronic cough, sputum or shortness of breath,” said Dr. Barry Make, co-senior author of the study and co-director of the COPD program at National Jewish Health. “Many of these patients can be quickly identified with the CAPTURE tool so that appropriate treatment can be started.”

While this study compared CAPTURE’s performance against spirometry, the project has a broader goal. Researchers want to determine if and how results from the screening influence the care physicians provide and, ultimately, the effects on patients’ health.

Partial funding for this research came from the National Institutes of Health.