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A new screening tool may help identify people with COPD who haven’t yet been diagnosed. Instants/Getty Images
  • Researchers say a 5-question screening tool may help diagnose people with treatable COPD.
  • They say the questionnaire helps identify people who should undergo specific testing for the pulmonary disease.
  • There has been some debate among medical professionals about the effectiveness of screening individuals for COPD who don’t have symptoms.

A new 5-question tool to help identify adults with undiagnosed, treatable chronic obstructive pulmonary disease (COPD) has been developed with the support of the National Heart, Lung, and Blood Institute.

The efficacy of the new screening tool was examined in a study published today in the journal JAMA Network.

Researchers conducted a multi-year, multi-site clinical trial from October 2018 until April 2022 with 4,325 participants between 45 and 80 years of age.

They used the COPD Assessment in Primary Care to Identify Undiagnosed Respiratory Disease & Exacerbation Risk (CAPTURE) screening tool.

Researchers said the CAPTURE system identified 53 of 110 previously undiagnosed study participants who had moderate to severe COPD.

However, the screening tool also provided 479 false positives. The scientists are looking at modifying or changing questions to improve accuracy.

All participants received COPD testing for the scientists to determine the results.

The CAPTURE screening tool consists of a five-question assessment.

The five questions are:

  • Have you ever lived or worked in a place with dirty or polluted air, smoke, second-hand smoke, or dust?
  • Does your breathing change with the seasons, weather, or air quality?
  • Does your breathing make it difficult to do such things as carry heavy loads, shovel dirt or snow, jog, play tennis, or swim?
  • Compared to others your age, do you tire easily?
  • In the past 12 months, how many times did you miss work, school, or other activities due to a cold, bronchitis, or pneumonia?

A score of 2 to 4 is indicative of moderate breathing issues.

Those participants then take an in-office breathing test called peak expiratory flow rate (PEFR) that measures the force of exhalation or lung function.

For women, a score of less than 250L/min suggests further COPD testing is needed. For men, it is 350 L/min.

People who score 5 or 6 on the CAPTURE screening do not need the PEFR. Instead, it’s recommended they have COPD testing.

The researchers expect 1 in 81 people who take the CAPTURE screening will be identified as having treatable but previously unidentified COPD.

“I think this is a promising step toward an easy-to-use screening tool for primary care physicians to identify those who might benefit from lung function testing to diagnose COPD,” said Dr. Jimmy Johannes, a pulmonologist and critical care medicine specialist at MemorialCare Long Beach Medical Center in California who was not involved in the study. “Nevertheless, the performance of this screening tool could be better; only about half of those diagnosed with COPD had a positive screening test.”

“However, implementing this screening tool may help standardize the approach to deciding who should undergo lung function testing,” Johannes told Healthline. “Importantly, it may also increase awareness among doctors and patients to think about lung health during a short clinic visit.“

In a 2022 report, the United States Preventive Services Task Force (USPSTF) recommended against screening asymptomatic people for COPD. This was a reaffirmation of a previous recommendation in 2016.

“The USPSTF reviewed the evidence for COPD and found that screening for COPD in asymptomatic adults has no net benefit,” task force members concluded.

The scientists conducting the current study disagree.

“The recommendation to not screen is because of a lack of studies evaluating the benefit of screening, not because there is no benefit to patients,” said Dr. Barry Make, the co-director of the COPD program at National Jewish Health and co-senior author of the study. “My view is that finding undiagnosed patients with COPD is beneficial because diagnosis and recognition will lead to earlier treatment and improve patient symptoms.”

“Symptoms in patients with COPD develop slowly and insidiously over a long period, and patients fail to recognize their slow development.” Make told Healthline. “For example, if you ask most people who are current smokers if they have cough and phlegm, they respond ‘no.’ However, if asked if they have a ‘smoker’s cough,’ the answer is more likely to be ‘yes’ with an additional refrain that this is normal and they had it for a long time.”

“As another example, people may ‘slow down’ and give up some activities,” Make added.
“They relate this to aging when it is due to COPD. To avoid the troubling symptom of shortness of breath, people unconsciously avoid activities that make them short of breath.”

Although he would like to see improvements in accuracy, Johannes does agree that there are benefits to early screening.

“COPD is underdiagnosed, leading to significant untreated symptom burden and overall morbidity,” he said. “Diagnosing COPD early may lead to earlier treatment and symptom improvement. An earlier diagnosis may help identify ongoing risk factors for COPD and create an opportunity to mitigate further lung function decline by modifying those risk factors. For example, it may help motivate those still smoking cigarettes to quit earlier.”

COPD refers to a group of diseases, including emphysema and chronic bronchitis, that cause airway blockage and breathing-related problems, according to the Centers for Disease Control and Prevention.

Estimates indicate that 16 million people in the United States have been diagnosed with COPD and millions more have it but have not been diagnosed.

There is no cure or way to reverse COPD, but treatments are available to make living with the symptoms more manageable.

According to the American Lung Association, symptoms include the following:

  • Chronic cough
  • Shortness of breath when doing everyday activities
  • Frequent respiratory infections
  • Blueness of lips or fingernail beds
  • Fatigue
  • Wheezing
  • Producing extra mucus

Spirometry is the most common diagnostic tool.

For this test, a person breathes into a mouthpiece with tubing connected to a machine. It measures lung function and can detect COPD before symptoms appear.

Other tests include a CT scan and arterial blood gas test to measure the oxygen in your blood.