Urgent care visits dropped by 50% among Canadians who responded to case-finding questionnaires and reported uncontrolled symptoms.

Many people with chronic obstructive pulmonary disease (COPD) or asthma have not received formal diagnoses. Researchers in Canada employed a ‘case-finding’ strategy to detect patients with undiagnosed respiratory disease: automated phone surveys to one million households identified almost 50,000 adults who reported respiratory symptoms and agreed to be contacted further. Among those, 5600 participants reported uncontrolled symptoms on asthma and COPD questionnaires, 2850 then underwent spirometry, and 508 had either irreversible or reversible obstruction (i.e. COPD or asthma, respectively) and were enrolled in the trial.

Participants were randomised to receive treatment from a pulmonologist and an asthma/COPD educator using GINA or GOLD (NEJM JW Gen Med May 15 2023 and Am J Respir Crit Care Med 2023; 207: 819-883) guideline-based care (intervention group) or were referred to their primary care physicians (usual-care group). During the 12-month study, respiratory-related urgent care visits were 50% lower in the intervention group (1.1 vs 0.5 events/person-year). Respiratory symptoms improved in both groups, with somewhat more improvement in the intervention group.

Comment: This trial shows that meaningful reductions in asthma/COPD exacerbations and symptoms can occur when patients are identified early and given guideline-based care. As evidenced by the numbers above, this could be a very time-consuming and expensive process. The labour-intensive intervention studied here is not immediately practical outside of a research setting. However, the findings could translate indirectly to primary care practice: when patients mention shortness of breath or nonspecific cough in passing during routine encounters, early identification of previously undiagnosed asthma and COPD – and early implementation of guideline-based care – could be beneficial.

David J. Amrol, MD, Associate Professor of Clinical Internal Medicine, Director of the Division of Allergy and Immunology, University of South Carolina School of Medicine, Columbia, USA.

Aaron SD, et al. Early diagnosis and treatment of COPD and asthma – a randomized, controlled trial. N Engl J Med 2024; 390: 2061-2073.

This summary is taken from the following Journal Watch titles: General Medicine, Ambulatory Medicine, Hospital Medicine.