Diagnosing COPD and supporting smoking cessation in general practice: Evidenceepractice gaps

Jenifer Liang, Michael J. Abramson, Nicholas A. Zwar, Grant M. Russell, Anne E. Holland, Billie Bonevski, Ajay Mahal, Kirsten Phillips, Paula Eustace, Eldho Paul, Sally Wilson, Johnson George

Research output: Contribution to journalArticleResearchpeer-review

3 Citations (Scopus)

Abstract

Objectives: To review the accuracy of diagnoses of chronic obstructive pulmonary disease (COPD) in primary care in Australia, and to describe smokers’ experiences with and preferences for smoking cessation. Design, setting and participants: Patients were invited to participate if they were at least 40 years old and had visited participating general practice clinics in Melbourne at least twice during the previous 12 months, reported being current or ex-smokers with a smoking history of at least 10 pack-years, or were being managed for COPD. Interviews based on a structured questionnaire and case finding (FEV1/FEV6 measurement) were followed, when appropriate, by spirometry testing and assessment of health-related quality of life, dyspnoea and symptoms. Results: 1050 patients attended baseline interviews (February 2015 - April 2017) at 41 practices. Of 245 participants managed for COPD, 130 (53.1%) met the spirometry-based definition (post-bronchodilator FEV1/FVC < 0.7) or had a clinical correlation; in 37% of cases COPD was not confirmed, and no definitive result was obtained for 9.8% of patients. Case finding and subsequent spirometry testing identified 142 new COPD cases (17.6% of participants without prior diagnosis; 95% CI, 15.1-20.5%). 690 participants (65.7%) were current smokers, of whom 360 had attempted quitting during the previous 12 months; 286 (81.0%of those attempting to quit) reported difficulties during previous quit attempts. Nicotine replacement therapy (205, 57.4%) and varenicline (110, 30.8%) were the most frequently employed pharmacological treatments; side effects were common. Hypnotherapy was the most popular non-pharmacological option (62 smokers, 17%); e-cigarettes were tried by 38 (11%). 187 current smokers (27.6%) would consider using e-cigarettes in future attempts to quit. Conclusions: COPD was both misdiagnosed and missed. Case finding and effective use of spirometry testing could improve diagnosis. Side effects of smoking cessation medications and difficulties during attempts to quit smoking are common. Health professionals should emphasise evidence-based treatments, and closely monitor quitting difficulties and side effects of cessation aids. Trial registration: Australian New Zealand Clinical Trials Registry ACTRN12614001155684.

Original languageEnglish
Pages (from-to)29-34
Number of pages6
JournalMedical Journal of Australia
Volume208
Issue number1
DOIs
Publication statusPublished - 15 Jan 2018
Externally publishedYes

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Smoking Cessation
General Practice
Chronic Obstructive Pulmonary Disease
Spirometry
Tobacco Products
Smoking
Interviews
Hypnosis
Bronchodilator Agents
Diagnostic Errors
Nicotine
New Zealand
Dyspnea
Registries
Professional Practice Gaps
Primary Health Care
Therapeutics
Quality of Life
Clinical Trials
Pharmacology

Cite this

Liang, J., Abramson, M. J., Zwar, N. A., Russell, G. M., Holland, A. E., Bonevski, B., ... George, J. (2018). Diagnosing COPD and supporting smoking cessation in general practice: Evidenceepractice gaps. Medical Journal of Australia, 208(1), 29-34. https://doi.org/10.5694/mja17.00664
Liang, Jenifer ; Abramson, Michael J. ; Zwar, Nicholas A. ; Russell, Grant M. ; Holland, Anne E. ; Bonevski, Billie ; Mahal, Ajay ; Phillips, Kirsten ; Eustace, Paula ; Paul, Eldho ; Wilson, Sally ; George, Johnson. / Diagnosing COPD and supporting smoking cessation in general practice : Evidenceepractice gaps. In: Medical Journal of Australia. 2018 ; Vol. 208, No. 1. pp. 29-34.
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abstract = "Objectives: To review the accuracy of diagnoses of chronic obstructive pulmonary disease (COPD) in primary care in Australia, and to describe smokers’ experiences with and preferences for smoking cessation. Design, setting and participants: Patients were invited to participate if they were at least 40 years old and had visited participating general practice clinics in Melbourne at least twice during the previous 12 months, reported being current or ex-smokers with a smoking history of at least 10 pack-years, or were being managed for COPD. Interviews based on a structured questionnaire and case finding (FEV1/FEV6 measurement) were followed, when appropriate, by spirometry testing and assessment of health-related quality of life, dyspnoea and symptoms. Results: 1050 patients attended baseline interviews (February 2015 - April 2017) at 41 practices. Of 245 participants managed for COPD, 130 (53.1{\%}) met the spirometry-based definition (post-bronchodilator FEV1/FVC < 0.7) or had a clinical correlation; in 37{\%} of cases COPD was not confirmed, and no definitive result was obtained for 9.8{\%} of patients. Case finding and subsequent spirometry testing identified 142 new COPD cases (17.6{\%} of participants without prior diagnosis; 95{\%} CI, 15.1-20.5{\%}). 690 participants (65.7{\%}) were current smokers, of whom 360 had attempted quitting during the previous 12 months; 286 (81.0{\%}of those attempting to quit) reported difficulties during previous quit attempts. Nicotine replacement therapy (205, 57.4{\%}) and varenicline (110, 30.8{\%}) were the most frequently employed pharmacological treatments; side effects were common. Hypnotherapy was the most popular non-pharmacological option (62 smokers, 17{\%}); e-cigarettes were tried by 38 (11{\%}). 187 current smokers (27.6{\%}) would consider using e-cigarettes in future attempts to quit. Conclusions: COPD was both misdiagnosed and missed. Case finding and effective use of spirometry testing could improve diagnosis. Side effects of smoking cessation medications and difficulties during attempts to quit smoking are common. Health professionals should emphasise evidence-based treatments, and closely monitor quitting difficulties and side effects of cessation aids. Trial registration: Australian New Zealand Clinical Trials Registry ACTRN12614001155684.",
author = "Jenifer Liang and Abramson, {Michael J.} and Zwar, {Nicholas A.} and Russell, {Grant M.} and Holland, {Anne E.} and Billie Bonevski and Ajay Mahal and Kirsten Phillips and Paula Eustace and Eldho Paul and Sally Wilson and Johnson George",
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Liang, J, Abramson, MJ, Zwar, NA, Russell, GM, Holland, AE, Bonevski, B, Mahal, A, Phillips, K, Eustace, P, Paul, E, Wilson, S & George, J 2018, 'Diagnosing COPD and supporting smoking cessation in general practice: Evidenceepractice gaps' Medical Journal of Australia, vol. 208, no. 1, pp. 29-34. https://doi.org/10.5694/mja17.00664

Diagnosing COPD and supporting smoking cessation in general practice : Evidenceepractice gaps. / Liang, Jenifer; Abramson, Michael J.; Zwar, Nicholas A.; Russell, Grant M.; Holland, Anne E.; Bonevski, Billie; Mahal, Ajay; Phillips, Kirsten; Eustace, Paula; Paul, Eldho; Wilson, Sally; George, Johnson.

In: Medical Journal of Australia, Vol. 208, No. 1, 15.01.2018, p. 29-34.

Research output: Contribution to journalArticleResearchpeer-review

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T1 - Diagnosing COPD and supporting smoking cessation in general practice

T2 - Evidenceepractice gaps

AU - Liang, Jenifer

AU - Abramson, Michael J.

AU - Zwar, Nicholas A.

AU - Russell, Grant M.

AU - Holland, Anne E.

AU - Bonevski, Billie

AU - Mahal, Ajay

AU - Phillips, Kirsten

AU - Eustace, Paula

AU - Paul, Eldho

AU - Wilson, Sally

AU - George, Johnson

PY - 2018/1/15

Y1 - 2018/1/15

N2 - Objectives: To review the accuracy of diagnoses of chronic obstructive pulmonary disease (COPD) in primary care in Australia, and to describe smokers’ experiences with and preferences for smoking cessation. Design, setting and participants: Patients were invited to participate if they were at least 40 years old and had visited participating general practice clinics in Melbourne at least twice during the previous 12 months, reported being current or ex-smokers with a smoking history of at least 10 pack-years, or were being managed for COPD. Interviews based on a structured questionnaire and case finding (FEV1/FEV6 measurement) were followed, when appropriate, by spirometry testing and assessment of health-related quality of life, dyspnoea and symptoms. Results: 1050 patients attended baseline interviews (February 2015 - April 2017) at 41 practices. Of 245 participants managed for COPD, 130 (53.1%) met the spirometry-based definition (post-bronchodilator FEV1/FVC < 0.7) or had a clinical correlation; in 37% of cases COPD was not confirmed, and no definitive result was obtained for 9.8% of patients. Case finding and subsequent spirometry testing identified 142 new COPD cases (17.6% of participants without prior diagnosis; 95% CI, 15.1-20.5%). 690 participants (65.7%) were current smokers, of whom 360 had attempted quitting during the previous 12 months; 286 (81.0%of those attempting to quit) reported difficulties during previous quit attempts. Nicotine replacement therapy (205, 57.4%) and varenicline (110, 30.8%) were the most frequently employed pharmacological treatments; side effects were common. Hypnotherapy was the most popular non-pharmacological option (62 smokers, 17%); e-cigarettes were tried by 38 (11%). 187 current smokers (27.6%) would consider using e-cigarettes in future attempts to quit. Conclusions: COPD was both misdiagnosed and missed. Case finding and effective use of spirometry testing could improve diagnosis. Side effects of smoking cessation medications and difficulties during attempts to quit smoking are common. Health professionals should emphasise evidence-based treatments, and closely monitor quitting difficulties and side effects of cessation aids. Trial registration: Australian New Zealand Clinical Trials Registry ACTRN12614001155684.

AB - Objectives: To review the accuracy of diagnoses of chronic obstructive pulmonary disease (COPD) in primary care in Australia, and to describe smokers’ experiences with and preferences for smoking cessation. Design, setting and participants: Patients were invited to participate if they were at least 40 years old and had visited participating general practice clinics in Melbourne at least twice during the previous 12 months, reported being current or ex-smokers with a smoking history of at least 10 pack-years, or were being managed for COPD. Interviews based on a structured questionnaire and case finding (FEV1/FEV6 measurement) were followed, when appropriate, by spirometry testing and assessment of health-related quality of life, dyspnoea and symptoms. Results: 1050 patients attended baseline interviews (February 2015 - April 2017) at 41 practices. Of 245 participants managed for COPD, 130 (53.1%) met the spirometry-based definition (post-bronchodilator FEV1/FVC < 0.7) or had a clinical correlation; in 37% of cases COPD was not confirmed, and no definitive result was obtained for 9.8% of patients. Case finding and subsequent spirometry testing identified 142 new COPD cases (17.6% of participants without prior diagnosis; 95% CI, 15.1-20.5%). 690 participants (65.7%) were current smokers, of whom 360 had attempted quitting during the previous 12 months; 286 (81.0%of those attempting to quit) reported difficulties during previous quit attempts. Nicotine replacement therapy (205, 57.4%) and varenicline (110, 30.8%) were the most frequently employed pharmacological treatments; side effects were common. Hypnotherapy was the most popular non-pharmacological option (62 smokers, 17%); e-cigarettes were tried by 38 (11%). 187 current smokers (27.6%) would consider using e-cigarettes in future attempts to quit. Conclusions: COPD was both misdiagnosed and missed. Case finding and effective use of spirometry testing could improve diagnosis. Side effects of smoking cessation medications and difficulties during attempts to quit smoking are common. Health professionals should emphasise evidence-based treatments, and closely monitor quitting difficulties and side effects of cessation aids. Trial registration: Australian New Zealand Clinical Trials Registry ACTRN12614001155684.

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