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A groundbreaking clinical trial has demonstrated that identifying and treating individuals with undiagnosed asthma or chronic obstructive pulmonary disease (COPD) significantly improves their health and reduces health care visits for respiratory symptoms. Published in the New England Journal of Medicine, this world-first study underscores the critical importance of early diagnosis and intervention.
Dr. Shawn Aaron, a senior scientist and lung specialist at The Ottawa Hospital and professor at the University of Ottawa, led the study. He emphasized the scope of undiagnosed respiratory diseases: “It’s estimated that 70% of people with asthma or COPD go undiagnosed. This is the first study to prove that treating those people makes a real difference to their health and quality of life.”
Identifying Undiagnosed Cases
From 2017 to 2023, the research team conducted a comprehensive search for undiagnosed cases across 17 study sites in Canada. They used automated phone calls to contact random households, inquiring if any adults had experienced unexplained shortness of breath, wheezing, prolonged cough, or mucus production in the past six months.
Of the 26,905 respondents reporting symptoms, a subset completed detailed questionnaires. Those likely to have asthma or COPD underwent spirometry tests, the gold standard for diagnosis. This process identified 595 individuals with asthma or COPD, and 508 of these agreed to participate in a randomized controlled trial.
Comparing Care Models
Participants were divided into two groups: one receiving usual care from their primary care provider or a walk-in clinic, and the other receiving specialized care from a lung specialist and an asthma/COPD educator. The specialized care group was prescribed inhalers and trained in their use. They also received personalized action plans for managing flare-ups, smoking cessation support, exercise and weight counseling, and appropriate vaccinations.
The results were compelling. In the specialized care group, 92% of patients started new medications for asthma or COPD, compared to 60% in the usual care group.
Improved Health Outcomes
Patients under specialized care averaged 0.53 health care visits per year for respiratory symptoms, compared to 1.12 visits for those receiving usual care. Additionally, patients in the specialized care group saw an average improvement of 10.2 points on the St. George’s Respiratory Questionnaire, a measure of health and quality of life, compared to a 6.8-point improvement in the usual care group. A four-point rise is considered significant.
Dr. Aaron highlighted the broader implications: “In the real world, not everyone can see a lung specialist. The good news is that as long as a patient gets diagnosed and treated, their symptoms will improve. The people in our study who went to primary care providers and walk-in clinics had great outcomes, and those who went to a lung specialist and asthma/COPD educator had excellent outcomes.”
A Personal Impact
Jazzminn Hein, a study participant, shared her transformative experience. Diagnosed with asthma at 24 after years of being misdiagnosed with anxiety, she saw a significant improvement in her symptoms and quality of life after starting treatment. “The asthma diagnosis makes a big difference,” she said. “I have two small kids now, and I can keep up with them. I sleep better because I used to regularly wake up struggling to breathe.”
A Call to Action
Asthma affects 8% of Canadian adults and can develop at any age, while COPD affects 8% of Canadians over 60. Dr. Aaron and study participants like Jazzminn advocate for greater awareness and proactive diagnosis. “If you have breathing symptoms like mine, go to your doctor or a walk-in clinic and ask for a spirometry test,” Jazzminn recommends. Dr. Aaron echoes this sentiment, emphasizing the need for patients to advocate for themselves and seek early diagnosis and treatment.
This landmark study highlights the profound impact of early diagnosis and treatment of asthma and COPD, offering a blueprint for improving patient outcomes and reducing healthcare costs.
For more information, refer to the study: Early Diagnosis and Treatment of COPD and Asthma: A Randomized, Controlled Trial, published in the New England
