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Early Diagnosis and Treatment of COPD and Asthma - A Randomized, Controlled Trial.
Aaron, Shawn D; Vandemheen, Katherine L; Whitmore, G Alex; Bergeron, Celine; Boulet, Louis-Philippe; Côté, Andréanne; McIvor, R Andrew; Penz, Erika; Field, Stephen K; Lemière, Catherine; Mayers, Irvin; Bhutani, Mohit; Azher, Tanweer; Lougheed, M Diane; Gupta, Samir; Ezer, Nicole; Licskai, Christopher J; Hernandez, Paul; Ainslie, Martha; Alvarez, Gonzalo G; Mulpuru, Sunita.
Affiliation
  • Aaron SD; From the Ottawa Hospital Research Institute, University of Ottawa, Ottawa (S.D.A., K.L.V., G.G.A., S.M.), the Desautels Faculty of Management (G.A.W.) and the Department of Medicine (N.E.), McGill University, and the Department of Medicine, Université de Montreal (C.L.), Montreal, the Department of
  • Vandemheen KL; From the Ottawa Hospital Research Institute, University of Ottawa, Ottawa (S.D.A., K.L.V., G.G.A., S.M.), the Desautels Faculty of Management (G.A.W.) and the Department of Medicine (N.E.), McGill University, and the Department of Medicine, Université de Montreal (C.L.), Montreal, the Department of
  • Whitmore GA; From the Ottawa Hospital Research Institute, University of Ottawa, Ottawa (S.D.A., K.L.V., G.G.A., S.M.), the Desautels Faculty of Management (G.A.W.) and the Department of Medicine (N.E.), McGill University, and the Department of Medicine, Université de Montreal (C.L.), Montreal, the Department of
  • Bergeron C; From the Ottawa Hospital Research Institute, University of Ottawa, Ottawa (S.D.A., K.L.V., G.G.A., S.M.), the Desautels Faculty of Management (G.A.W.) and the Department of Medicine (N.E.), McGill University, and the Department of Medicine, Université de Montreal (C.L.), Montreal, the Department of
  • Boulet LP; From the Ottawa Hospital Research Institute, University of Ottawa, Ottawa (S.D.A., K.L.V., G.G.A., S.M.), the Desautels Faculty of Management (G.A.W.) and the Department of Medicine (N.E.), McGill University, and the Department of Medicine, Université de Montreal (C.L.), Montreal, the Department of
  • Côté A; From the Ottawa Hospital Research Institute, University of Ottawa, Ottawa (S.D.A., K.L.V., G.G.A., S.M.), the Desautels Faculty of Management (G.A.W.) and the Department of Medicine (N.E.), McGill University, and the Department of Medicine, Université de Montreal (C.L.), Montreal, the Department of
  • McIvor RA; From the Ottawa Hospital Research Institute, University of Ottawa, Ottawa (S.D.A., K.L.V., G.G.A., S.M.), the Desautels Faculty of Management (G.A.W.) and the Department of Medicine (N.E.), McGill University, and the Department of Medicine, Université de Montreal (C.L.), Montreal, the Department of
  • Penz E; From the Ottawa Hospital Research Institute, University of Ottawa, Ottawa (S.D.A., K.L.V., G.G.A., S.M.), the Desautels Faculty of Management (G.A.W.) and the Department of Medicine (N.E.), McGill University, and the Department of Medicine, Université de Montreal (C.L.), Montreal, the Department of
  • Field SK; From the Ottawa Hospital Research Institute, University of Ottawa, Ottawa (S.D.A., K.L.V., G.G.A., S.M.), the Desautels Faculty of Management (G.A.W.) and the Department of Medicine (N.E.), McGill University, and the Department of Medicine, Université de Montreal (C.L.), Montreal, the Department of
  • Lemière C; From the Ottawa Hospital Research Institute, University of Ottawa, Ottawa (S.D.A., K.L.V., G.G.A., S.M.), the Desautels Faculty of Management (G.A.W.) and the Department of Medicine (N.E.), McGill University, and the Department of Medicine, Université de Montreal (C.L.), Montreal, the Department of
  • Mayers I; From the Ottawa Hospital Research Institute, University of Ottawa, Ottawa (S.D.A., K.L.V., G.G.A., S.M.), the Desautels Faculty of Management (G.A.W.) and the Department of Medicine (N.E.), McGill University, and the Department of Medicine, Université de Montreal (C.L.), Montreal, the Department of
  • Bhutani M; From the Ottawa Hospital Research Institute, University of Ottawa, Ottawa (S.D.A., K.L.V., G.G.A., S.M.), the Desautels Faculty of Management (G.A.W.) and the Department of Medicine (N.E.), McGill University, and the Department of Medicine, Université de Montreal (C.L.), Montreal, the Department of
  • Azher T; From the Ottawa Hospital Research Institute, University of Ottawa, Ottawa (S.D.A., K.L.V., G.G.A., S.M.), the Desautels Faculty of Management (G.A.W.) and the Department of Medicine (N.E.), McGill University, and the Department of Medicine, Université de Montreal (C.L.), Montreal, the Department of
  • Lougheed MD; From the Ottawa Hospital Research Institute, University of Ottawa, Ottawa (S.D.A., K.L.V., G.G.A., S.M.), the Desautels Faculty of Management (G.A.W.) and the Department of Medicine (N.E.), McGill University, and the Department of Medicine, Université de Montreal (C.L.), Montreal, the Department of
  • Gupta S; From the Ottawa Hospital Research Institute, University of Ottawa, Ottawa (S.D.A., K.L.V., G.G.A., S.M.), the Desautels Faculty of Management (G.A.W.) and the Department of Medicine (N.E.), McGill University, and the Department of Medicine, Université de Montreal (C.L.), Montreal, the Department of
  • Ezer N; From the Ottawa Hospital Research Institute, University of Ottawa, Ottawa (S.D.A., K.L.V., G.G.A., S.M.), the Desautels Faculty of Management (G.A.W.) and the Department of Medicine (N.E.), McGill University, and the Department of Medicine, Université de Montreal (C.L.), Montreal, the Department of
  • Licskai CJ; From the Ottawa Hospital Research Institute, University of Ottawa, Ottawa (S.D.A., K.L.V., G.G.A., S.M.), the Desautels Faculty of Management (G.A.W.) and the Department of Medicine (N.E.), McGill University, and the Department of Medicine, Université de Montreal (C.L.), Montreal, the Department of
  • Hernandez P; From the Ottawa Hospital Research Institute, University of Ottawa, Ottawa (S.D.A., K.L.V., G.G.A., S.M.), the Desautels Faculty of Management (G.A.W.) and the Department of Medicine (N.E.), McGill University, and the Department of Medicine, Université de Montreal (C.L.), Montreal, the Department of
  • Ainslie M; From the Ottawa Hospital Research Institute, University of Ottawa, Ottawa (S.D.A., K.L.V., G.G.A., S.M.), the Desautels Faculty of Management (G.A.W.) and the Department of Medicine (N.E.), McGill University, and the Department of Medicine, Université de Montreal (C.L.), Montreal, the Department of
  • Alvarez GG; From the Ottawa Hospital Research Institute, University of Ottawa, Ottawa (S.D.A., K.L.V., G.G.A., S.M.), the Desautels Faculty of Management (G.A.W.) and the Department of Medicine (N.E.), McGill University, and the Department of Medicine, Université de Montreal (C.L.), Montreal, the Department of
  • Mulpuru S; From the Ottawa Hospital Research Institute, University of Ottawa, Ottawa (S.D.A., K.L.V., G.G.A., S.M.), the Desautels Faculty of Management (G.A.W.) and the Department of Medicine (N.E.), McGill University, and the Department of Medicine, Université de Montreal (C.L.), Montreal, the Department of
N Engl J Med ; 390(22): 2061-2073, 2024 Jun 13.
Article in En | MEDLINE | ID: mdl-38767248
ABSTRACT

BACKGROUND:

Many persons with chronic obstructive pulmonary disease (COPD) or asthma have not received a diagnosis, so their respiratory symptoms remain largely untreated.

METHODS:

We used a case-finding method to identify adults in the community with respiratory symptoms without diagnosed lung disease. Participants who were found to have undiagnosed COPD or asthma on spirometry were enrolled in a multicenter, randomized, controlled trial to determine whether early diagnosis and treatment reduces health care utilization for respiratory illness and improves health outcomes. Participants were assigned to receive the intervention (evaluation by a pulmonologist and an asthma-COPD educator who were instructed to initiate guideline-based care) or usual care by their primary care practitioner. The primary outcome was the annualized rate of participant-initiated health care utilization for respiratory illness. Secondary outcomes included changes from baseline to 1 year in disease-specific quality of life, as assessed with the St. George Respiratory Questionnaire (SGRQ; scores range from 0 to 100, with lower scores indicating better health status); symptom burden, as assessed with the COPD Assessment Test (CAT; scores range from 0 to 40, with lower scores indicating better health status); and forced expiratory volume in 1 second (FEV1).

RESULTS:

Of 38,353 persons interviewed, 595 were found to have undiagnosed COPD or asthma and 508 underwent randomization 253 were assigned to the intervention group and 255 to the usual-care group. The annualized rate of a primary-outcome event was lower in the intervention group than in the usual-care group (0.53 vs. 1.12 events per person-year; incidence rate ratio, 0.48; 95% confidence interval [CI], 0.36 to 0.63; P<0.001). At 12 months, the SGRQ score was lower than the baseline score by 10.2 points in the intervention group and by 6.8 points in the usual-care group (difference, -3.5 points; 95% CI, -6.0 to -0.9), and the CAT score was lower than the baseline score by 3.8 points and 2.6 points, respectively (difference, -1.3 points; 95% CI, -2.4 to -0.1). The FEV1 increased by 119 ml in the intervention group and by 22 ml in the usual-care group (difference, 94 ml; 95% CI, 50 to 138). The incidence of adverse events was similar in the trial groups.

CONCLUSIONS:

In this trial in which a strategy was used to identify adults in the community with undiagnosed asthma or COPD, those who received pulmonologist-directed treatment had less subsequent health care utilization for respiratory illness than those who received usual care. (Funded by Canadian Institutes of Health Research; UCAP ClinicalTrials.gov number, NCT03148210.).
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Full text: 1 Database: MEDLINE Main subject: Quality of Life / Asthma / Pulmonary Disease, Chronic Obstructive / Early Diagnosis Limits: Adult / Aged / Female / Humans / Male / Middle aged Country/Region as subject: America do norte Language: En Journal: N Engl J Med Year: 2024 Type: Article
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Full text: 1 Database: MEDLINE Main subject: Quality of Life / Asthma / Pulmonary Disease, Chronic Obstructive / Early Diagnosis Limits: Adult / Aged / Female / Humans / Male / Middle aged Country/Region as subject: America do norte Language: En Journal: N Engl J Med Year: 2024 Type: Article