Improvement in COPD diagnosis rate through widespread use of Spirometry
A large number of COPD cases are found by outpatient spirometry test
The number of COPD patients in Japan is estimated to be 5,300,000, but only about 200,000 patients receive treatment since COPD is often overlooked during their regular doctor's visit. Some of the reasons why COPD is overlooked are that the symptoms are cough, sputum production, and shortness of breath, which are all too common, and because COPD progresses slowly, it makes it harder for the patients to recognize it. In addition, physicians can also be faulted because the rate of pulmonary function tests performed is low, which makes COPD hard to diagnose.
An air of pessimism surrounds the idea that COPD is a disease that, for most part, cannot completely be reversed. Consequently, COPD has not been treated aggressively. In reviewing the management of COPD patients after diagnosis, COPD is not managed in many cases even in patients with moderate-COPD who need drug therapy according to the guidelines. Thus, it appears that in many cases, COPD is diagnosed but not treated.
In order to improve the COPD diagnosis rate and to promote early treatment, it is considered necessary to raise public recognition of the disease COPD with the cooperation of the media, to incorporate spirometry testing into physical checkups, and to strongly encourage outpatients in the department of general internal medicine to get a spirometry test.
For example, an obstructive disorder was found in as many as 15.9% of the target population aged 40 or older, after actively implementing a spirometry test on outpatients at the department of internal medicine in our hospital, in order to investigate how much detection of COPD can be gained (Figure 1). COPD was found in 42.9% of these patients with an obstructive disorder after a thorough examination at the respiratory department (Figure 2). These newly diagnosed patients would not have been aware of their disorder if they had not undergone the spirometry test. In other words, it has been proven useful to incorporate a spirometry test into the general outpatient examination.
In regard to pessimism for treatment, recently introduced long-acting bronchodilators are remarkably effective in COPD patients compared to conventional drugs, and with comprehensive treatment including oxygen therapy and exercise training, COPD has become a treatable disease. We would like to continue to encourage early detection and early treatment of COPD by being actively engaged in spirometry testing in the department of general medicine.
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