Specialized Care of Undiagnosed Asthma and COPD Patients Halves Healthcare Utilization and symptom burden: NEJM
Researchers have found that identifying symptomatic individuals with undiagnosed asthma and chronic obstructive pulmonary disease (COPD) and linking them with specialty care significantly reduces healthcare utilization and symptom burden. This finding stems from a randomized trial conducted in Canada, which highlights the benefits of early diagnosis and pulmonologist-directed care. This trial was published in The New England Journal Of Medicine by Aaron SD. and colleagues.
Undiagnosed respiratory diseases such as asthma and COPD are common in the community, often leading to poor quality of life and increased healthcare utilization. Early diagnosis and appropriate treatment can mitigate disease progression and reduce acute care needs. The Undiagnosed COPD and Asthma Population (UCAP) Study aimed to assess the impact of specialist care on healthcare utilization and symptom management in patients with newly diagnosed asthma or COPD.
The UCAP trial involved over a million households near 17 trial sites in Canada, screened through automated telephone calls to identify individuals with respiratory symptoms. Ultimately, 508 adults with newly diagnosed COPD (n=258) or asthma (n=250) were randomized to receive pulmonologist-directed care or usual care with a primary care provider. Participants were followed for one year, and primary outcomes included the annualized rate of healthcare utilization for respiratory illness. Secondary outcomes focused on disease-specific quality of life, symptom burden, and lung function.
• Intervention group had 0.53 vs. 1.12 events per person-year (IRR 0.48, 95% CI 0.36-0.63, P<0.001).
• Significant reduction in primary care visits (0.36 vs. 0.91 per person-year; IRR 0.39, 95% CI 0.29-0.53).
• SGRQ total score improvement of -3.5 points (95% CI -6.0 to -0.9).
• CAT total score improvement of -1.3 points (95% CI -2.4 to -0.1).
• Pre-bronchodilator FEV1 improvement of 94 ml (95% CI 50-138).
• 92% of the intervention group vs. 60% of the usual-care group started new asthma or COPD medications.
• 14% of active smokers in the intervention group quit smoking vs. 7% in the usual care group.
The findings indicate that specialized care significantly reduces healthcare utilization and improves quality of life and lung function in patients with newly diagnosed asthma or COPD. Participants in the intervention group benefited from guideline-based treatment, including medication prescriptions, disease education, behavioral counseling, and recommendations for vaccinations and smoking cessation.
The study revealed some limitations, including potential biases due to the requirement for a registered telephone number and the higher willingness of older adults to participate. The approach may also be less feasible in healthcare systems with limited access to specialty care. Despite these challenges, the results emphasize the potential benefits of early diagnosis and specialized care in managing asthma and COPD.
The UCAP trial demonstrates that linking symptomatic individuals with undiagnosed asthma or COPD to pulmonologist-directed care significantly reduces healthcare utilization and improves disease-specific outcomes. This study highlights the need for effective case-finding strategies and specialized care to enhance the management of respiratory diseases in the community.
Reference:
Aaron, S. D., Vandemheen, K. L., Whitmore, G. A., Bergeron, C., Boulet, L.-P., Côté, A., McIvor, R. A., Penz, E., Field, S. K., Lemière, C., Mayers, I., Bhutani, M., Azher, T., Lougheed, M. D., Gupta, S., Ezer, N., Licskai, C. J., Hernandez, P., Ainslie, M., … Mulpuru, S. (2024). Early diagnosis and treatment of COPD and asthma — A randomized, controlled trial. The New England Journal of Medicine. https://doi.org/10.1056/nejmoa2401389
