A New Simple Way to Find Undiagnosed Cases of Chronic Obstructive Pulmonary Disease (COPD)
L. Normal Lungs & R. Lungs with COPD (NHLBI)
Chronic obstructive pulmonary disease (COPD) is a very serious progressive lung disorder that leads to serious breathing difficulties. It is also known as emphysema and chronic bronchitis. It is characterized by:
- Coughing that brings up a lot of slimy mucus and phlegm that may be clear or white, green or yellow in color.
- Shortness of breath
- Tightness in the chest from trying to breathe
- Wheezing
- Fatigue from straining to breathe plus a lack of oxygen
- Prone to respiratory infections
According to the National heart, Lung and Blood Institute (NHLBI), about 16 million Americans suffer from COPD, which is a major cause of disability and the 4th leading cause of death in the United States. The main risk factor for developing COPD is smoking that makes up 75% of the cases. Not all people with COPD smoke, but environmental pollution, chemical fumes, second-hand smoke and exposure to lung irritants in the work place can also lead to COPD. In some rare cases genetics can also play a part.
Millions of People with COPD Undiagnosed
Millions of people with COPD do not even know they have it, as it has not been diagnosed. This is unfortunate because, while it is presently considered to be incurable, it is treatable and much can be done to ease the symptoms of COPD and to help a person carry on with day-to-day activities.
The CAPTURE Questionnaire
In fact, the earlier treatment is begun, the greater will be the chance to have a better quality of life and to slow the downhill progress of COPD. Dr. Fernando Martinez – Chief of Pulmonary and Critical Care Medicine at Weill Cornell Medicine and Medical Center New York has designed a simple CAPTURE questionnaire with five pertinent questions that can help find undiagnosed people with COPD who can be treated before it gets much worse.
The Five CAPTURE Questions
- Have you ever lived or worked in a place with dirty or polluted air, smoke, second-hand smoke or dust?
- Does your breathing change with seasons, weather or air quality?
- Does your breathing make it difficult to do things such as carry heavy loads, shovel dirt or snow, jog, play tennis or swim?
- Compared to others your age, do you tire easily?
- In the past 12 months, how many times did you miss work, school or other activities due to a cold, bronchitis or pneumonia?
Calculating the Score
Each of the first four questions that are answered with a “yes” get one point
These points are then added to the number of missed events in the 5th question.
Less than two total points means that the person probably does not have COPD.
Those people who have two to four points should be followed up with a peak flow test.
A person who shows poor results to the peak flow test or who gets five or more points on the questionnaire should be sent to do a spirometry test. Results of the spirometry test can lead to a positive diagnosis for COPD.
New Large Study to Examine Effectiveness of CAPTURE
The CAPTURE questionnaire has been translated into 14 languages and is in use for academic purposes all over the world. However, a new large study is being planned by Dr. Martinez with the participation of 5000 people in 100 primary care centers around the country in various and diverse kinds of communities. The study will see if primary care physicians are ready to take an extra 5-10 minutes per visit to question patients with the five questions from CAPTURE. The study will also examine if patients were able to receive treatments that improved their quality of life such as medications, pulmonary rehabilitation therapy and other non-medical treatments. While COPD is considered to be incurable, nonetheless, the search goes on for new treatments. In our blog post from September 21, 2018, we wrote about a breakthrough Zephyr Endobronchial Valve that is able to improve breathing for people suffering from COPD.
The Need for Long-term Care
Many patients with severe COPD end up needing to go to a skilled long-term rehabilitation and nursing facility such as the Van Duyn Center for Rehabilitation and Nursing in Syracuse, New York. Van Duyn has a Respiratory Wellness unit that is staffed by professional respiratory therapists. Van Duyn also has wonderful recreational therapy programs and the air in Syracuse has been rated by the American Lung Association for being among the cleanest cities in America for fine particle air pollution:
- Ranked 122 for high ozone days out of 227 metropolitan areas
- Tied for 1st for cleanest metropolitan areas in the country for 24-hour particle pollution
- Ranked 174 for annual particle pollution out of 187 metropolitan areas
Conclusion
Let us hope that the CAPTURE questionnaire designed by Dr. Martinez will be successful in finding the millions of people with COPD that do not know they have it, so they can begin treatment which will help improve the quality of their lives.