UCAP: Identify and treat undiagnosed COPD or asthma

Individuals with undiagnosed chronic obstructive pulmonary disease (COPD) or asthma can be found in the community by targeting their symptoms using case-finding. Once they are identified, guideline-directed therapy by a pulmonologist or, to a lesser extent, usual care by a primary care practitioner can improve these people’s health situation.

“Up to 70% of the patients with COPD or asthma remain undiagnosed in the community [1],” claimed Dr Shawn Aaron (Ottawa
Hospital Research Institute, Canada). “The US national health and nutritional examination survey of 2007–2012 revealed that 13% of the randomly selected adults had obstructive lung disease, with 71% being undiagnosed.” Next, a study that was published in December 2023 showed that people with undiagnosed COPD or asthma have a poorer quality-of-life, a greater need for healthcare utilisation, and poorer work productivity, compared with healthy age matched controls [2]. Here, the UCAP study (NCT03148210), short for ‘undiagnosed COPD and asthma in the population’ aimed to answer 3 questions related to this clinical problem:

• Can we find adults with undiagnosed asthma or COPD in the community?
• Are these patients ill?
• Can these patients be treated early to improve health outcomes?

Through case-finding, 2,857 adults with respiratory symptoms and no history of diagnosed lung disease underwent spirometry, revealing that 21% of them had undiagnosed asthma or COPD [3]. To answer the last question, 508 patients with previously undiagnosed asthma or COPD were randomised 1:1 to a guideline-based treatment, provided by a pulmonologist and asthma/ COPD educator, or to usual care, provided by the patients’ primary care practitioner. The primary outcome was the annual rate of patient- initiated healthcare utilisation events for respiratory illness. Dr Aaron mentioned that 92% and 60% of the patients had started medication for COPD or asthma during the study in the ‘pulmonologist’ and ‘primary care practitioner’ arms, respectively. The incidencerate ratio for the primary outcome
measure was 0.48 in favour of the ‘pulmonologist’ arm (P<0.001). Also, quality-of-life scores improved significantly in both groups over the 12-month study duration.

“We can improve healthcare utilisation, symptoms, and quality-of-life in patients with undiagnosed COPD or asthma through guideline-directed treatment by a pulmonologist/educator,” summarised Dr Aaron. “With usual care, the results are less remarkable but still significant. This is important because, in the real world, not everyone can see a lung specialist.”

1. Martinez CH, et al. Ann Am Thorac Soc. 2015;12(12):1788-1795.
2. Gerstein E, et al. Am J Respir Crit Care Med. 2023;208(12):1271-1282.
3. Aaron SD, et al. Early diagnosis and treatment of COPD and asthma: a randomized controlled trial. Late-breaking abstracts: science that will impact clinical care. ATS 2024, 17–22 May, San Diego, USA.

Medical writing support was provided by Robert van den Heuvel.

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Posted on 10 June 202410 June 2024