Is generalization of exhaled CO assessment in primary care helpful for early diagnosis of COPD?

Type Article
Date 2015-04
Language English
Author(s) Molinari Nicolas1, 2, Abou-Badra Mathieu3, Marin Gregory1, Ky Chin-Long4, Amador Noemi1, Gamez Anne Sophie3, Vachier Isabelle3, Bourdin Arnaud2, 3
Affiliation(s) 1 : CHU Montpellier, Hop Le Colombiere, Dept Med Informat, Montpellier, France.
2 : Univ Montpellier, INSERM, CNRS UMR 9214, PhyMedExp, F-34059 Montpellier, France.
3 : CHU Montpellier, Dept Resp Dis, Montpellier, France.
4 : IFREMER, CIP, UMR EIO241, Tahiti, Fr Polynesia.
Source Bmc Pulmonary Medicine (1471-2466) (Biomed Central Ltd), 2015-04 , Vol. 15 , N. 44 , P. 1-7
DOI 10.1186/s12890-015-0039-6
WOS© Times Cited 2
Keyword(s) COPD, Screening, Exhaled CO, Smoking, Behaviour
Abstract Background: COPD is largely under-diagnosed and once diagnosed usually at a late stage. Early diagnosis is thoroughly recommended but most attempts failed as the disease is marginally known and screening marginally accepted. It is a rare cause of concern in primary care and spirometry is not very common. Exhaled carbon monoxide (eCO) is a 5-seconds easy-to-use device dedicated to monitor cigarette smoke consumption. We aimed to assess whether systematic eCO measurement in primary care is a useful tool to improve acceptance for early COPD diagnosis. Methods: This was a two-center randomized controlled trial enrolling 410 patients between March and May, 2013. Whatever was the reason of attendance to the clinic, all adults were proposed to measure eCO during randomly chosen days and outcomes were compared between the two different groups of patients (performing and not performing eCO). Primary outcome was the rates of acceptance for COPD screening. Results: Rate of acceptance for COPD screening was 28% in the eCO group and 26% in the other (P = 0.575). These rates increased to 48 and 51% in smokers (current and former). eCO significantly increased the rate of clinics during which a debate on smoking was initiated (42 vs. 24%, P = 0.001). eCO at 2.5 ppm was the discriminative concentration for identifying active smokers (ROC curve AUC: 0.935). Smoking was the only independent risk factor associated with acceptance for early COPD screening (OR = 364.6 (82.5-901.5) and OR = 78.5 (18.7-330.0) in current and former smokers, respectively) while eCO measurement was not. Conclusions: Early COPD diagnosis is a minor cause of concern in primary care. Systematic eCO assessment failed to improve acceptance for early COPD screening.
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Molinari Nicolas, Abou-Badra Mathieu, Marin Gregory, Ky Chin-Long, Amador Noemi, Gamez Anne Sophie, Vachier Isabelle, Bourdin Arnaud (2015). Is generalization of exhaled CO assessment in primary care helpful for early diagnosis of COPD? Bmc Pulmonary Medicine, 15(44), 1-7. Publisher's official version : , Open Access version :