Implications for practice and research
respiratory pathologies, COPD
COPD
Organising the pathway to access spirometry and taking on the role of COPD coordinator can be done by medical assistants; when this study was undertaken, the medical assistant post had not been created in France, but it does exist in primary care in other countries. The study presented here shows that such organisation enables early detection of new cases of COPD. This is particularly useful for health systems in which spirometry is not performed in GP practices. Following the study presented here, a medico-economic evaluation of using a coordinator is being developed after DISCO.GPs allocated to a study intervention prescribed spirometry while none in the control group did so; this highlights the underuse of spirometry in primary care in real life. A further concern is that only 42% of prescribed spirometry was performed. The reasons for this require further study. This study was designed as an active case- finding study, adapted to French primary health care, to detect patients at risk of COPD. In a large proportion of patients identified as being at risk, spirometry was not performed, which highlights the critical need to not only identify patients at risk of COPD, but also to convince them to complete spirometry when it is prescribed.Performing spirometry as soon as COPD is suspected would likely increase the number of new COPD cases detected. A recent pooled analysis of three Danish studies assessed the use of a mini- spirometry, then spirometry, to detect COPD in primary care;The search for risk factors and early symptoms of COPD has, therefore, made it possible to start a respiratory health pathway, not only for new COPD patients, but also for other respiratory pathologies diagnosed in the interventional groups.Assessing COPD risk factors and symptoms in primary care allows GPs to detect COPD. GOLD questions alone can be a useful aid in identifying potential new COPD cases, and using a COPD coordinator to organise spirometry can increase the number of new cases of COPD detected. These interventions are relatively straightforward to implement in primary practice, particularly in countries such as France, where most GPs have not been trained to perform spirometry.The authors would like to thank the GPs who participated in this study (MA Arrondel, S Blais, E Blanchard, J Boulier, L Bourges, M Brochard, M Brosset, H Charbonnel, S Chisloup, Y Chuberre, A Couatarmanac’h, A De Guibert, L Delatte, A Doncieux, M Dufils- Gelgon, JP Duguey, S Duquenne, I Ezanno, E Foure- Amelot, M Frin, A Gelgon, A Giguet, L Guichard, S Guillaume, G Hamonic, L Idlas- Nouveau, A Jarno- Josse, J Kerouredan, P Le Boucher, L Lenoble, E Maes, S Mallard, PA Moinard, A Moutel, L Murgale, P Neau, B Negaret, R Nifenecker, PY Pieto, Y Prigent, N Roger, M Salacroup, B Tanguy, G Tanguy, G Tapin, J Thual, and C Zagrodka), as well as the DISCO research staff (J Fouchard, C Fougerou, J Hérault, C Laforest, S Lahaye, N Nourdine, MC Quinquenel, V Turmel, and B Yourish). The authors would also like to thank Catherine de Bournonville and Graziella Brinchault for their support and advice, and Trevor Stanbury (Pro-Pens) for medical writing assistance. This article is supported by Hôpitaux Universitaires du Grand Ouest, the French network of university hospitals.