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COPD-screening bij ouderen heeft weinig effect

  • Onderzoek
  • Published:
Huisarts en wetenschap Aims and scope

Samenvatting

Bertens LCM, Reitsma JB, Van Mourik Y, Lammers JWJ, Moons KGM,Hoes AW, Rutten FH. COPD-screening bij ouderen heeft weinig effect.Huisarts Wet 2015;58(5):242-4.

Doel

Nagaan of een screening op COPD bij thuiswonende kwetsbare ouderen met klachten van kortademigheid of verminderd inspanningsvermogen zinvol zou kunnen zijn. Daartoe bepaalden we het medicatiegebruik, het aantal ziekenhuisopnames en de sterfte onder patiënten bij wie de screening leidde tot een eerste diagnose COPD.

Methode

Een panel van deskundigen bepaalde de diagnose op basis van alle screeningsgegevens, inclusief spirometrie. Follow-upgegevens verzamelden we via de deelnemende huisartsen.

Resultaten

De screening werd uitgevoerd bij 386 oudere huisartspatiënten met kortademigheid of inspanningstolerantie. Bij 84 (21,8%) patiënten leidde de screening tot een niet eerder gestelde diagnose COPD. Van deze 84 waren er 15 (17,9%) binnen zes maanden na de diagnose gestart met inhalatiemedicatie of ze hadden hun bestaande medicatie aangepast, en waren er 27 (32,1%) binnen twaalf maanden opgenomen in een ziekenhuis. In de groep bij wie de screening geen COPD had aangetoond, lag dit laatste percentage significant lager (22,9%). De mortaliteit was in beide groepen vergelijkbaar.

Conclusie

Door kwetsbare ouderen te screenen kunnen veel nieuwe gevallen van COPD worden ontdekt. De screening heeft echter weinig consequenties voor de daaropvolgende behandeling. Een mogelijke verklaring is dat patiënten die niet zelf met hun klachten naar de huisarts stappen, waarschijnlijk toch al minder gemotiveerd zijn voor behandeling.

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Literatuur

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    Article  CAS  PubMed  Google Scholar 

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    Article  CAS  PubMed  Google Scholar 

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    Article  PubMed  Google Scholar 

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    PubMed  Google Scholar 

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    Article  CAS  PubMed  Google Scholar 

  22. Bednarek M, Maciejewski J, Wozniak M, Kuca P, Zielinski J. Prevalence, severity and underdiagnosis of COPD in the primary care setting. Thorax 2008;63:402–7.

    Article  CAS  PubMed  Google Scholar 

  23. Broekhuizen BD, Sachs AP, Hoes AW, Moons KG, Van den Berg JW, Dalinghaus WH, et al. Undetected chronic obstructive pulmonary disease and asthma in people over 50 years with persistent cough. Br J Gen Pract 2010;60:489–94.

    Article  PubMed Central  PubMed  Google Scholar 

  24. Geijer RM, Sachs AP, Hoes AW, Salome PL, Lammers JW, Verheij TJ. Prevalence of undetected persistent airflow obstruction in male smokers 40-65 years old. Fam Pract 2005;22:485–9.

    Article  PubMed  Google Scholar 

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    Article  Google Scholar 

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    Article  CAS  PubMed  Google Scholar 

  27. Scarlata S, Pedone C, Fimognari FL, Bellia V, Forastiere F, Incalzi RA. Restrictive pulmonary dysfunction at spirometry and mortality in the elderly. Respir Med 2008;102:1349–54.

    Article  PubMed  Google Scholar 

  28. Faggiano P. Abnormalities of pulmonary function in congestive heart failure. Int J Cardiol 1994;44:1–8.

    Article  CAS  PubMed  Google Scholar 

  29. Güder G, Rutten FH, Brenner S, Angermann CE, Berliner D, Ertl G, et al. The impact of heart failure on the classification of COPD severity. J Card Fail 2012;18:637–44.

    Article  PubMed  Google Scholar 

  30. Guerra S, Sherrill DL, Venker C, Ceccato CM, Halonen M, Martinez FD. Morbidity and mortality associated with the restrictive spirometric pattern: a longitudinal study. Thorax 2010;65:499–504.

    Article  PubMed Central  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Julius Centrum voor gezondheidswetenschappen en huisartsgeneeskunde, UMC Utrecht, Stratenum 6.131, 3508, Utrecht, AB, The Netherlands

    Loes Bertens

  2. http://www.bsl.nl

    Johannes Reitsma, Yvonne van Mourik,  Jan-Willem Lammers,  Karel Moons &  Arno Hoes

  3. afdeling Longziekten, UMC Utrecht, Utrecht, The Netherlands

    Frans Rutten

Authors
  1. Loes Bertens
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  2. Johannes Reitsma
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  3. Yvonne van Mourik
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  4. Jan-Willem Lammers
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  5. Karel Moons
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  6. Arno Hoes
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  7. Frans Rutten
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Corresponding author

Correspondence to Loes Bertens.

Additional information

UMC Utrecht, Julius Centrum voor gezondheidswetenschappen en huisartsgeneeskunde. Stratenum 6.131, 3508 AB Utrecht: dr. L.C.M. Bertens, klinisch epidemioloog; dr. J.B. Reitsma, klinisch epidemioloog; Y. van Mourik, MD, huisarts; prof.dr. K.G.M. Moons, klinisch epidemioloog; prof.dr. A.W. Hoes, klinisch epidemioloog; dr. F.H. Rutten, huisarts-onderzoeker. UMC Utrecht, afdeling Longziekten: prof.dr. J.W.J. Lammers, longarts • Correspondentie: L.C.M.Bertens-2@umcutrecht.nl • Mogelijke belangenverstrengeling: niets aangegeven.

Dit artikel is een bewerkte vertaling van Bertens LC, Reitsma JB, Van Mourik Y, Lammers JW, Moons KG, Hoes AW, Rutten FH. COPD detected with screening: impact on patient management and prognosis. Eur Respir J 2014;44:1571-8. Publicatie gebeurt met toestemming van de uitgever.

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Bertens, L., Reitsma, J., van Mourik, Y. et al. COPD-screening bij ouderen heeft weinig effect. HUISARTS WETENSCHAP 58, 242–244 (2015). https://doi.org/10.1007/s12445-015-0131-4

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  • DOI: https://doi.org/10.1007/s12445-015-0131-4

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