Accessibility statement

DOC – An RCT to Determine the Optimal approach to identifying individuals with Chronic obstructive pulmonary disease

Early identification of chronic obstructive pulmonary disease (COPD) results in patients receiving appropriate management for their condition sooner. Our trial found that routine use of the peak flow meter or microspirometer in primary care for suspected COPD could reduce referrals for spirometric testing.

Why did we do this research?

COPD impacts mortality and morbitity, impairs quality of life and is under-diagnosed. Early identification of COPD results in patients receiving appropriate management for their condition at an earlier stage in their disease. The DOC study evaluated the diagnostic accuracy of a series of simple lung function tests and symptom-based case-finding questionnaires to enhance early identification of COPD.

What did we do?

Eligible individuals were invited to undertake a series of case-finding tools, which comprised lung function tests (specifically, spirometry, microspirometry, peak flow meter, and WheezoMeter) and several case-finding questionnaires. The effectiveness of these tests, individually or in combination, to identify small airways obstruction was evaluated against the gold standard of spirometry.

Who was involved?

The study was conducted with general practices in the Yorkshire and Humberside area, in the UK. A total of 444 current smokers aged 35 or more agreed to take part and completed their study appointments. 

What did we find?

Our findings inform the choice of test for COPD identification; case-finding by use of the peak flow meter or microspirometer could be used routinely in primary care for suspected COPD patients. Only those testing positive to these tests would move on to full spirometry, thereby reducing unnecessary spirometric testing.

Publications

  • Ronaldson SJ, Dyson L, Clark L, Hewitt CE, et al. Determining the optimal approach to identifying individuals with chronic obstructive pulmonary disease: The DOC study. J Eval Clin Pract. 2018 Jun;24(3):487-495. https://doi.org10.1111/jep.12896. PMID: 29536597.
  • Ronaldson SJ, Dyson L, Clark L, Hewitt CE, et al. The impact of lung function case-finding tests on smoking behaviour: A nested randomised trial within a case-finding cohort. Health Sci Rep. 2018 May 18;1(6):e41. https://doi.org10.1002/hsr2.41 PMID: 30623078

Team

Department of Health Sciences, University of York, York, 

 

  • Cooper BG, 

Queen Elizabeth Hospital Birmingham, University of Birmingham, Birmingham, 

 

  • Kearney M

NHS England and Public Health England, London, 

 

  • Laughey W

Hull York Medical School, York,

 

  • Raghunath R
  • Steele L

James Alexander Family Practice, Hull, England

 

  • Rhodes R

Escrick Surgery, York, 

 

  • Joy Adamson

Institute of Health and Society, Newcastle University, Newcastle

Funding

The research was funded by the Department for Health. The project started in August 2010 and was completed in December 2013.

Study Registration

Trial registration ISRCTN 42132522