Back to Annual Meeting Page		American Public Health Association 133rd Annual Meeting & Exposition December 10-14, 2005 Philadelphia, PA

Abstract #112028

Joseph Menzin, PhD¹, Jeffrey S. Brown, PhD¹, Lisa Guadagno, MS², Maryellen Simmons, CRT², Barrett Kitch, MD³, Jeno P. Marton, MD⁴, Mark Friedman, MD¹, and Jianwei Xuan, PhD⁴. (1) Boston Health Economics, Inc., 20 Fox Road, Waltham, MA 02451, (781) 290-0808, jmenzin@bhei.com, (2) Blue Cross and Blue Shield of Rhode Island, Health and Wellness Division, 15 LaSalle Square, Providence, RI 02903, (3) Brigham and Women’s Hospital, 50 Staniford St., Boston, MA 02114, (4) US Outcomes Research Group, Pfizer Global Pharmaceuticals, 235 East 42nd Street, New York, NY 10017

Background/Objectives: Chronic obstructive pulmonary disease (COPD) is the fourth leading cause of death in the U.S., and is associated with substantial cost, disability, and impairment of quality of life. Detection and diagnosis of COPD is difficult without use of spirometry, particularly in early stage disease. However, spirometry is not routinely used in those at highest risk (e.g., smokers), often delaying diagnosis and treatment until the disease has progressed. This analysis examines the feasibility of implementing a community-based spirometry screening program to assess the clinical and economic burden of undiagnosed COPD. Methods: Spirometry was recently incorporated into ongoing employer and community health screenings offered by a health plan, with all participants eligible. Screening is conducted using a portable spirometer (EasyOne^TM Diagnostic Spirometer 2.0, ndd Medical Technologies, Andover, MA). The manufacturer trained clinical staff to perform spirometry. Consistent with guidelines, valid spirometry was defined as having at least two acceptable and reproducible maneuvers. Logistic regression was used to explore predictors of a valid spirometry test. Data for the study were collected from August through December 2004. Results: To date, 824 subjects have undergone spirometry; 69% participated at worksites, 19% at senior centers, and 13% at community sites. The mean age of subjects was 50.4 years and 62% were female. About 55% of subjects were current or former smokers, 9% reported chronic respiratory symptoms, and 13% reported asthma. Valid spirometry was achieved by 646 (78%) subjects. Males (odds ratio [OR] 0.60, 95% C.I. 0.42-0.85; p<0.004) and those screened at senior centers versus community health fairs (OR 0.45, 95% C.I. 0.24-0.85; p<0.01) were less likely to achieve a valid test. Persons screened in the later months of the study were more likely to achieve a valid test (OR 1.19, 95% C.I. 1.00-1.42; p<0.05), indicating that study technicians improved their testing procedures over time. Self-reported asthma, presence of respiratory symptoms, smoking status, and screening at worksites were not significantly associated with test validity. Study clinicians noted that common reasons for invalid tests were poor technique and shortness of breath or coughing during testing, and that the most important factors in obtaining a valid test were demonstrating proper technique and coaching. Conclusion: Our preliminary results suggest that community-based spirometry screening yields acceptable and reproducible spirometric tests, and may be a reasonable addition to community screening programs, which may facilitate case finding and lead to improved outcomes.

Learning Objectives: After attendance, session participants will be able to

• Describe the issues related to undiagnosed lung disease
• Describe the impediments in assessing the burden of undiagnosed lung disease
• Discuss the feasibility of community-based spirometry screening as a way of identifying undiagnosed lung disease and studying the clinical and economic burden of undiagnosed disease.

Keywords: Community-Based Health Promotion, Screening

Presenting author's disclosure statement:

I wish to disclose that I have NO financial interests or other relationship with the manufactures of commercial products, suppliers of commercial services or commertial supporters WITH THE EXCEPTION OF Research funding was provided by Pfizer, Inc..