Abstract

Background and Aim
1/4 people with COPD wait more than five years for a diagnosis, 1/8 wait more than 10 years.
The delays have exacerbated post-pandemic resulting in significant waiting lists with potential for decreased quality of life, increased morbidity, and increased healthcare utilisation.
TargetCOPD showed a case-finding approach yielded increased COPD diagnosis, when compared to routine practice (4% vs 1%).
BREATHE is a collaborative working project involving Chiesi Ltd and 17 Practices within Fuller and Forbes Healthcare Group across England, with National Services for Health Improvement (NSHI) providing clinical services.
The first phase of the BREATHE project aimed to implement a clinical pathway in primary care for patients awaiting COPD diagnostic spirometry.
Methods
Phase 1 of the collaboration was undertaken from November to December 2024.
Patients were identified who were either currently on a list awaiting COPD diagnostic spirometry, or via ‘case finder’ searches described in figure 1.
Identified patients were invited to attend a diagnostic clinic comprising of:
• Clinical assessment using LungHealth® Diagnostic spirometry and
• Spirometry (FEV6) (ArtiQ© AI spirometry) with post bronchodilator reversibility.
Results
• 103 patients (mean age 60 (SD 15) years; 41% male) were reviewed, with COPD diagnosis rate of 39.8% (41/103).
• Those diagnosed with COPD were statistically significantly more likely to be older (mean age 68 (SD 10) v 55 (SD 16) years; p<0.05), male (54 v 30%; p<0.05) and have a greater degree of breathlessness (mMRC score>=2: 27% v 10%; p<0.05) compared with those not diagnosed with COPD (n=62).
• Of those patients diagnosed with COPD, 56% were in GOLD Stage 1, 32% in GOLD Stage 2 and 12% were in GOLD Stage 3.
Discussion
Phase 1 of BREATHE has demonstrated the feasibility of utilising a bespoke case finding pathway in primary care to enhance diagnosis rate of COPD. We demonstrated a diagnosis rate of 39.8% compared to 4% in TargetCOPD.
This model also utilised AI spirometry, which could potentially allow Healthcare Assistants to complete spirometry as part of a COPD diagnostic clinic. This could offer a scalable solution to help tackle the spirometry backlog and find the missing millions.