Objective: Chronic obstructive pulmonary disease (COPD) is a common disease,
the early diagnosis of which allows effective management and treatment.
The aim of the present study is to show the effectiveness of a screening
and monitoring plan for COPD in high-risk patients in primary health care.Patients
and methods: The subjects in this prospective observational longitudinal
study comprised 164 high-risk smokers aged between 40 and 76 years. Age,
sex, weight, height, and smoking habit (pack-years) were recorded and
spirometry was performed according to the guidelines of the Spanish Society
of Pulmonology and Thoracic Surgery (SEPAR). Patients were informed of
their results and given brief advice on how to stop smoking. After 3 years,
the patients underwent the same evaluation.Results: In 1999, 22% of the
smokers were diagnosed with COPD. Three years later, an additional 16.3%
were diagnosed as having COPD, and the disease had worsened in 38.8% of
those already diagnosed. Of the patients with a forced expiratory volume
in one second (FEV1) less than 90%, 44.8% developed COPD (relative risk:
10.54). An accelerated decrease in FEV1 was found in 18.1% of the patients
(20.7% with COPD and 9.0% without COPD).Mean tobacco consumption in 1999
was 28.1 pack-years in subjects without COPD and 31.7 pack-years in those
with COPD, whereas in 2002, consumption was 30.6 pack-years in patients
with COPD and 31.9 pack-years in those without. In 3 years, 22.8% had
stopped smoking (20.5% without COPD and 30.3% with COPD).Conclusions:
Many smokers managed to give up smoking after learning their spirometric
results. FEV1 can identify smokers at greatest risk of developing COPD.
Spirometric screening and monitoring of smokers at high risk in primary
health care can identify those most susceptible to developing COPD while
the disease is in an early phase. Therefore the most appropriate strategy
can be adopted for each patient.