1 of 2 | Lead author Dr. Shawn Aaron, a senior scientist and lung specialist at The Ottawa Hospital in Ottawa, Ontario, Canada, described the research as “the world’s first study to find people with undiagnosed asthma or COPD in their homes,” Photo courtesy of The Ottawa Hospital
NEW YORK, May 19 (UPI) — Finding and treating people with undiagnosed asthma or chronic obstructive pulmonary disease improved their health and led to fewer appointments for respiratory symptoms in the year after detection, a new study indicates.
The results were published Sunday in the New England Journal of Medicine.
“This is the world’s first study to find people with undiagnosed asthma or COPD in their homes,” said the study’s lead author, Dr. Shawn Aaron, a senior scientist and lung specialist at The Ottawa Hospital in Ottawa, Ontario, Canada.
“They are suffering because they are without a diagnosis or treatment, and if we set out to diagnose them early and treat them, we can make them much better,” said Aaron, who also is a professor at the University of Ottawa.
He added that an estimated 70% of people with asthma or COPD are undiagnosed.
To find undetected cases, the research team reached out to random telephone numbers at 17 study locations across Canada from 2017 to 2023. An automated call inquired whether any adults in the household had unexplained shortness of breath, wheezing or prolonged cough, or were coughing up mucus in the past six months.
The 26,905 people who indicated experiencing these symptoms completed questionnaires. Those most likely to have asthma or COPD also took a spirometry breathing test — the gold standard for diagnosing either condition.
A total of 595 people received a diagnosis of asthma or COPD, and 508 consented to enrolling in a randomized, controlled trial to compare different kinds of care.
Researchers assigned half of trial participants to usual care (their primary care provider or a walk-in-clinic) and the other half to lung specialists and asthma/COPD educators (specially trained nurses or respiratory therapists) for treatment.
A lung specialist and educator prescribed inhalers and taught patients how to use them. Some participants received action plans to help manage disease flare-ups on their own. They also obtained smoking cessation treatment, exercise and weight counseling, and pneumonia and flu vaccines, if appropriate.
Of the people seen by a lung specialist or asthma/COPD educator, 92% began new medications, compared to 60% of patients getting usual care.
Patients under the care of a lung specialist and asthma/COPD educator averaged 0.53 health care visits for respiratory symptoms in the year after diagnosis, compared to 1.12 visits in the usual care group.
Their average score on the St. George’s Respiratory Questionnaire increased by 10.2 points, compared to 6.8 points for usual care participants. A four-point rise signifies an improvement in health and quality of life.
The outcomes were impressive for both groups, Aaron said, adding long waiting lists exist to see specialists in Canada.
At age 24, Jazzminn Hein answered an automated call inviting her to participate in the study after she had given birth to her first of two children.
A week or two before the call, she had gone on a walk, pushing her daughter in a stroller up a small hill. When she reached the top, she said, it took five to 10 minutes to catch her breath.
“I started having problems when I was very young, like 7 or 8 years old,” said Hein, now 28 and a resident of Hastings Highlands, Ontario. “If I was outside playing tag with my friends, they would be able to run a lot more than I could. I would be out of breath a lot of faster.”
Although Hein “felt like an elephant was sitting on my chest,” healthcare providers dismissed her breathing complaints as anxiety attacks. But then, thanks to the study, she found out she has asthma and received an inhaler, which she said made a huge difference.
“I don’t get nearly as many headaches,” Hein said. “I’m not yawning 50 times a day. I’m not walking up at night without the ability to breathe.”
Dr. Kevin Simpson, a professor of pulmonary and critical care medicine at Loyola University Medical Center in Maywood, Ill., said “this study suggests that we are presently missing opportunities to improve the respiratory status of a significant number of people.” He was not involved in the study.
Patients should discuss any persistent shortness of breath, chest tightness, wheezing and cough with their health care providers, while acknowledging that “office visits can feel rushed at times, and it can be a challenge to decide how to best utilize that limited time,” Simpson said.
In prior decades, many physicians regarded COPD as a disease that couldn’t be treated, but this study demonstrated that using inhalers improved lung function, reduced symptoms and decreased the risk of respiratory infections, said Dr. M. Bradley Drummond, an associate professor in the division of pulmonary diseases and critical care at the University of North Carolina-Chapel Hill.
In addition to using spirometry to diagnose asthma, COPD, pulmonary fibrosis and other conditions that compromise breathing, doctors can order it to check lung function before surgery or to assess the effectiveness of medication and treatment. The test requires breathing into a mouthpiece attached to a device called a spirometer, experts say.
Most physician offices do not have this test available, while lung specialists and hospitals typically do, said Dr. David Mannino, a pulmonologist and chief medical officer of the COPD Foundation in Miami.
“One takes a deep breath in, then blasts out quickly until your lungs have emptied all air — sort of like blowing out candles on a birthday cake,” Mannino said.
To obtain the best results, people should perform this maneuver at least three times. A technician may give medicine to help open airways before a patient repeats the test, said Dr. Amy Attaway, a pulmonologist and associate director of the COPD center at Cleveland Clinic.
“Spirometry tests are usually highly accurate when performed correctly,” Attaway said.
However, patients may become lightheaded, dizzy or have chest tightness due to the test, said Dr. Dixie Harris, a pulmonary medicine and critical care physician at Intermountain Health in Salt Lake City.
People should avoid or postpose testing if they have experienced a recent heart attack, stroke, certain types of surgery, a collapsed lung, respiratory infection such as tuberculosis or COVID-19, a large or growing thoracic or abdominal aneurysm, coughing up blood, or increased brain pressure, Harris said.
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