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Identifying symptomatic individuals in the community with undiagnosed asthma and chronic obstructive pulmonary disease (COPD), and then linking them with pulmonologist care, reduced healthcare utilization and symptom burden, according to a randomized trial reported at the recent American Thoracic Society annual meeting.

In this exclusive MedPage Today video, investigator Shawn Aaron, MD, of the University of Ottawa in Ontario, discusses the background and results of the study.

Following is a transcript of his remarks:

The whole idea for this study stems from my clinical work. So I'm a pulmonologist and I see patients in consultation, and many of them come in complaining of months or years of respiratory symptoms. So they've had cough or shortness of breath or wheezing, but they come in without a diagnosis. And when they see me, I diagnose asthma or COPD for the first time.

And so I wondered, is this happening in the community? Is this a major problem where there are people, adults in the community who are suffering from respiratory symptoms, but who are going undiagnosed and untreated? So that was the impetus for doing this study where we tried to find people with respiratory symptoms in Canada who were undiagnosed and untreated, and we tried to see if we could improve their health.

We set out to find people with respiratory symptoms who had never been previously diagnosed with lung disease. And we did that basically through an AI-assisted program. So we hired a commercial survey company to create lists of cell phone numbers and landline phone numbers within 90 minutes travel time of each of our 17 sites across Canada. And then the survey company would call these phone numbers using automated dialing. So automated dialing, everybody knows about this, those annoying phone calls that come in at 6:00 p.m. when you're trying to get supper done. And oftentimes people will get these automated phone calls and hang up. But we started the automated phone call, it was a recorded voice from a study nurse. And the nurse would say, for instance, "Hi, my name is Joanne, and I'm a nurse at the Ottawa Hospital. And we're looking to do a study in people with respiratory symptoms, that is cough or shortness of breath or wheezing. And if you've had these symptoms in the last 6 months and you're interested in finding out more about this study, please press 1 on your telephone."

And so we did this to find the patients with respiratory symptoms. Once we found these people, we actually called them back. A study nurse would phone them back, would question them about their symptoms, and would actually administer two COPD and asthma symptom questionnaire tests. And if the patient had significant respiratory symptoms, and if they had no previous history of lung disease, then we would bring them into our study and we would test them with a test called spirometry. Spirometry is just a simple test that determines whether patients are breathing out appropriate volumes of air and breathing out at the appropriate speed. And if they don't, we can diagnose COPD or asthma from this test.

And based on this, we tested 2,900 people with spirometry. These were people with respiratory symptoms who had no previous history of diagnosed lung disease, and we found that 21% had undiagnosed asthma or COPD.

The takeaway is we then enrolled these people with undiagnosed asthma, COPD in a clinical trial, and we treated them with guidelines-based therapy. And over 1 year, we saw excellent outcomes. The group that saw pulmonologists and got guidelines-based therapy had half the rate of healthcare utilization for respiratory illness compared to the group that got usual care and quality of life and symptoms and lung function improved dramatically over 1 year. So we found that we could find these patients, diagnose their disease, and then if we treated them, they got dramatically better.

So the takeaway here for people in the community is that if you're suffering from undiagnosed respiratory symptoms, you need to see your doctor. You need to insist on spirometry. And if you do these things, diagnoses of asthma or COPD can be made. And then the treatment is simple and easy and will make you feel much better.

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