NIH/NHLBI, PBRN clinics, researchers and COPD Foundation collaborate to test COPD screening tool
PBRNs in collaboration with academic physician-scientists and the COPD Foundation (COPDF) are studying how primary care clinics can identify and treat more people with chronic obstructive pulmonary disease (COPD)
The NIH-supported CAPTURE screening tool to help primary care clinics identify adults with undiagnosed chronic obstructive pulmonary disease (COPD) shows promise, according to research published in JAMA.
The COPD Assessment in Primary Care to Identify Undiagnosed Respiratory Disease & Exacerbation Risk (CAPTURE), which is supported by the National Heart, Lung, and Blood Institute (NHLBI), was developed to identify adults with COPD symptoms severe enough to treat, but who may miss a diagnosis. COPD affects more than 15 million Americans, about 1 in 12 adults. However, about half of people living with COPD are undiagnosed.
The clinical trial was designed by physician researchers, funded by NHLBI, implemented in seven primary care based Practice Based Research Networks (PBRNs) and supported by staff of the COPDF. The CAPTURE clinical trial enrolled 4,325 adults, ages 45-80, none of whom had a prior COPD diagnosis between Oct. 12, 2018 and April 1, 2022. Overall, 110 participants, 2.5% of the study sample were found to have undiagnosed moderate to severe COPD. CAPTURE identified 53, or 48%, of these cases. The screening criteria provided positive screens for 479 participants, 11%, without COPD.
“The goal with trying to find COPD is to treat it earlier, which will help make patients feel better and hopefully prevent their disease from progressing,” said Fernando J. Martinez, M.D., a principal investigator of the study and chief of the Division of Pulmonary and Critical Care Medicine at Weill Cornell Medicine, New York City. “The primary care PBRNs were an excellent place for this study using a real-world population in this clinical trial” reported co-investigator Barbara Yawn, MD of the University of Minnesota Department of Family and Community Health and the COPDF.
“Common COPD symptoms include coughing, shortness of breath, wheezing or whistling in the chest, and feeling chest tightness or heaviness. People with more advanced cases may experience limitations with regular activities and periods of marked limitations due to COPD flare-ups or exacerbations. Treatment can include different types of inhaler delivered medications, pulmonary rehabilitation, and support with quitting smoking” said David Mannino, MD study co-investigator and medical director of the COPDF.
As part of CAPTURE screening, the PBRN research coordinators ask patients to complete the five questions of CAPTURE, assessing breathing, activity and exposure to chemicals and air pollution issues Those with medium scores of 2-4, indicative of some problems also completed a peak flow breathing measure to obtain a final screening score. Those with moderate scores and low peak flow as well as those higher questionnaire scores of 5-6 were considered screen positive and recommended for further evaluation including lung function testing.
Byron Thomashow, MD, co-founder and Chief Medical Officer of the COPDF, study investigator, and Professor Emeritus Columbia University Medical Center, emphasizes that currently the goal for CAPTURE is not to diagnose COPD, but to identify patients who would benefit from the further evaluation like spirometry.
“CAPTURE was designed to be easy for physicians to use,” said Barbara Yawn, MD MSc. “The screening is simple, and can be completed in primary care offices.” Based on this analysis, 1 out of every 81 CAPTURE screenings would identify an adult with treatable but previously undiagnosed COPD.
“The study shows that there is a high degree of respiratory burden in primary care and physicians need to ask about it and do the appropriate testing to determine if symptoms are driven by COPD or another process so that patients can get appropriate treatment,” said MeiLan K. Han, M.D., a principal investigator of the study and a professor of medicine in the Division of Pulmonary and Critical Care at the University of Michigan, Ann Arbor.
Additional studies are also needed to see if CAPTURE improves patient health outcomes. Larger studies assessing the tool are underway and results are expected to be available later this year. "The COPDF will continue to support and participate in this important work." said Elisha Malanga, COPDF Corporate Relations Officer.
Study: Martinez FJ, Han MK, Lopez C, et al. Discriminate accuracy of the CAPTURE tool for identifying chronic obstructive pulmonary disease in US primary care settings. JAMA. 2023; doi:10.1001/jama.2023.0128.
About the Foundation
The COPD Foundation is a not-for-profit organization established to improve the lives of people with COPD, bronchiectasis, and nontuberculous mycobacterial (NTM) lung disease through initiatives that expand services and speed innovations to make treatment more effective and affordable. The Foundation does this through scientific research, education, advocacy, and awareness to prevent disease, slow progression, and find a cure. For more information, visit copdfoundation.org, or follow us on Twitter and LinkedIn.