Public Health Researcher Develops Innovative Tool to Quicken COPD Diagnosis

LEXINGTON, Ky. (Oct. 2, 2015) — An umbrella term for impaired lung function, chronic obstructive pulmonary disease (COPD) describes a number of diseases such as emphysema, chronic bronchitis and some types of asthma. More than 12 million Americans were diagnosed with COPD in 2011, but the Centers for Disease Control and Prevention estimate twice that number suffer from undiagnosed cases.

Patients with COPD experience reductions in lung function, which interfere with their ability to perform routine activities. Modern medical therapies and disease management practices for COPD can delay lung impairment and improve the patient’s quality of life. According to Dr. David Mannino, at least a third of Americans living with COPD discover their diagnosis after experiencing late-stage disease exacerbations. At this point, lung deterioration eliminates the possibility of intervention.

“Undiagnosed and untreated COPD can lead to detriments in quality of life, and basically people start doing less because they have difficulty breathing,” Mannino, a professor in the UK College of Public Health, said. “Many people attribute this difficulty of breathing to just getting older when, in fact, they may have a disease that is potentially treatable. With the appropriate therapy and interventions, our patients can live near to normal lives and do many of the things that they would like to do.”

Mannino collaborated with a national team of public health experts to develop a novel tool intended to hasten the process of detecting and diagnosing cases of COPD in moderate to severely impaired patients. Maninno, professor and chair of the Department of Preventive Medicine and Environmental Health in the UK College of Public Health, led a team of researchers charged by the National Institutes of Health (NIH) Heart, Lung and Blood Institute with designing a direct and timely process for identifying cases of COPD in the primary care setting. As the presenting author on the project and principal investigator on the grant awarded by the NIH, Maninno reported on the findings from a study examining the effectiveness a five-step diagnostic tool during a meeting of the European Respiratory Society in Amsterdam on Sept. 29.

The three-year trial tested the diagnostic effectiveness of a simple patient questionnaire, as well as two common methods for diagnosing COPD: a peak flow examination and spirometry. A peak flow procedure measures the amount of air pushed from the patient’s lungs and a spirometer calculates the air capacity of the lungs. The experimental design tested all three methods, with an additional condition of peak flow used in conjunction with the questionnaire, in patients with clinically-significant COPD and patients with mild or no COPD. Study results supported the five-series questionnaire paired with the peak flow condition as the most effective of the three diagnostic approaches.

The tool poses five simple “yes or no” questions related to the patient’s lifestyle. Questions ask about pollutant exposure in workplace environments, frequency of respiratory infections, energy levels, and occurrences of pneumonia. The tool did not ask about smoking history. Once tested in more populations, Mannino believes this tool can enable health providers to diagnose COPD in a matter of seconds, but will also help proactive patients find out whether they are suffering from COPD symptoms before a doctor’s visit.

“What we would like to see is that this tool be used certainly in primary care practices,” Mannino said. “There is the potential that this is something that could be used by individuals to screen themselves and sort of give them something to talk about with their physician.”

While smoking is a significant predictor of COPD, it is not the sole cause of the disease.

Previous screening methods to diagnose COPD relied on the smoking history of patients, as well as patient cough and sputum, as the primary determinants of a diagnosis. According to Mannino, COPD is caused by a number of factors, including surrounding environments and occupational hazards. Mannino said high rates of smoking parallel with high rates of COPD in Kentucky, but a number of other factors, such as coal mining, environmental dust and poverty, put Kentuckians at a high risk of COPD.

A 2011 survey reported 9.8 percent of Kentuckians have received a diagnosis of COPD from their doctor. Oxygen therapies and medications can help alleviate symptoms of COPD at an early stage. 

In the next stage of the project, Mannino and colleagues will test the effectiveness of the five-question tool in different populations.

MEDIA CONTACT: Elizabeth Adams, elizabethadams@uky.edu