The New England Journal of MedicineEarly Diagnosis and Treatment of COPD and Asthma — A Randomized, Controlled Trial

Early Intervention in Undiagnosed COPD and Asthma Reduces Health Care Utilization and Improves Health Outcomes

Early diagnosis and treatment of chronic obstructive pulmonary disease (COPD) and asthma significantly reduce health care utilization for respiratory illness and improve health outcomes, according to a randomized, controlled trial. The study targeted individuals with undiagnosed respiratory conditions, revealing substantial benefits from pulmonologist-directed care over usual primary care practices.

Study Design:

• Participants: 38,353 adults interviewed, 595 identified with undiagnosed COPD or asthma; 508 randomized (253 to intervention, 255 to usual care).
• Intervention: Evaluation by a pulmonologist and an asthma-COPD educator initiating guideline-based care.
• Control: Usual care by primary care practitioners.
• Primary Outcome: Annualized rate of participant-initiated health care utilization for respiratory illness.
• Secondary Outcomes: Changes in quality of life (SGRQ), symptom burden (CAT), and lung function (FEV1) over 12 months.

Key Findings:

• Health Care Utilization: Intervention group had a lower annualized rate of primary-outcome events (0.53 vs. 1.12 events per person-year; incidence rate ratio, 0.48; 95% CI, 0.36 to 0.63; P<0.001).
• Quality of Life: SGRQ score improvement greater in the intervention group (-10.2 points) compared to the usual-care group (-6.8 points); difference of -3.5 points (95% CI, -6.0 to -0.9).
• Symptom Burden: CAT score improvement greater in the intervention group (-3.8 points) compared to the usual-care group (-2.6 points); difference of -1.3 points (95% CI, -2.4 to -0.1).
• Lung Function: FEV1 increased by 119 ml in the intervention group versus 22 ml in the usual-care group; difference of 94 ml (95% CI, 50 to 138).
• Adverse Events: Similar incidence between the intervention and usual-care groups.

HCN Medical Memo
This study stresses the importance of early identification and specialist-directed treatment in undiagnosed COPD and asthma, leading to better patient outcomes and reduced health care utilization. Implementing similar strategies in clinical practice can enhance the management of respiratory conditions and improve patients’ quality of life.

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