In search of the ‘Hidden Millions’ and how we can find them: The findings of Phase 1 of the FRONTIER project; a nurse led one stop COPD diagnostic clinic. (ID 615)
Hull University Teaching Hospitals
Abstract
Introduction
It is estimated that three million people in the UK have Chronic Obstructive Pulmonary Disease (COPD), of which two million are undiagnosed. COPD is the second most common reason for hospital admission and the fifth biggest killer in the UK. The importance of timely and accurate diagnosis has been widely acknowledged yet access to diagnostic testing remains problematic. Late diagnosis is associated with increased exacerbations, co-morbidities, and costs, The FRONTIER project has addressed this unmet need by providing spirometry testing for Lung Health Check participants who missed the opportunity to have spirometry testing during the COVID19 pandemic.
Aims and objectives
To report COPD diagnosis rate and clinical characteristics of participants attending a one-stop nurse-led COPD diagnostic clinic from October 2023 to October 2024.
Methods
Lung Health Check participants who reported symptoms and/or had emphysema on low dose CT were invited to a one-stop nurse-led diagnostic clinic (FRONTIER project). Routinely collected data from the clinic (pre and post bronchodilator spirometry, clinical features and patient reported outcomes) were analysed to determine COPD diagnosis rates, severity and recommended treatment strategies.
Results
819 patients (mean [SD] age 68.2 [7.4] years, n (%) 440 (53.7) male) were reviewed over 12 months. 383 (46.8%) where diagnosed with COPD with 210 (54.8%) categorised as having mild, 155 (40.5%) moderate, 17 (4.4%) Severe and 1 (0.3%) very severe airflow limitation based on Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria. Almost half (n=190) of those diagnosed were current smokers with a mean (SD) smoking pack year history of 41.6 (22.9). 40% accepted referral to NHS stop smoking services. Of 169 eligible for Pulmonary Rehabilitation 62% (n=105) consented to referral. Pharmacological treatment was initiated in line with the trust formulary with LABA/LAMA recommended in 67% (n=258) and LABA-LAMA-ICS in 32% (n=122) of patients diagnosed with COPD.
Conclusion
The FRONTIER Project demonstrates that Lung Health Checks can be utilised to undertake COPD case finding. Providing spirometry within a one-stop diagnostic clinic for those with reported symptoms and/or emphysema has resulted in a high diagnostic yield, highlighting the value of the project in enabling timely diagnosis of COPD.
Funding: Part Chiesi Ltd and part NHS (Humber Healthcare Partnership) as part of a collaborative working agreement.
Conflicts of interest: Chiesi Ltd.
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