Predischarge screening for chronic obstructive pulmonary disease in patients with acute coronary syndrome and smoking history. (1st November 2016)

• Record Type: Journal Article
• Authors: Campo, Gianluca; Pavasini, Rita; Barbetta, Carlo; Maietti, Elisa; Mascetti, Susanna; Biscaglia, Simone; Zaraket, Fatima; Spitaleri, Giosafat; Gallo, Francesco; Tonet, Elisabetta; Papi, Alberto; Ferrari, Roberto; Contoli, Marco
• Is Part Of: International journal of cardiology. Volume 222(2016)
• Page Start: 806
• Page End: 812
• Publication Date: 2016-11-01
• Subjects: Acute coronary syndrome -- Chronic obstructive pulmonary disease -- Screening -- Peak expiratory flow rate -- Respiratory health screening questionnaire; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2016.08.030
• Languages: English
• ISSNs: 0167-5273

Abstract

Abstract: Background: Several studies suggested that chronic obstructive pulmonary disease (COPD) is largely underdiagnosed in patients with acute coronary syndrome (ACS) contributing to further affect clinical outcome. Our aim was to validate a screening procedure to identify, in ACS patients, those with negligible risk of undiagnosed COPD. Methods: From December 2014 to August 2015, 169 ACS patients with smoking history underwent screening procedure. Screening procedure combined peak expiratory flow rate (PEFR, defined as positive if < 80% of predicted) and respiratory health status questionnaire (RHSQ, defined as positive if > 19.5 points). The screening was considered negative if both tests provided negative results, positive if both were positive, uncertain in presence of discrepancy. Spirometry was planned after 2 months to identify or not the presence of irreversible airflow obstruction (undiagnosed COPD). The primary endpoint was the negative predictive value of screening for undiagnosed COPD. Results: Overall, 137 (81%) patients received spirometry (final study population). Screening was negative, uncertain and positive in 58 (42%), 46 (34%) and 33 (24%) patients, respectively. We found undiagnosed COPD in 39 (29%) patients. Only 3 patients with negative screening showed undiagnosed COPD. Negative screening showed the best ability to discriminate patients without COPD (negative predictive value 95%). Two-month health status in patients with undiagnosed COPD was significantly poor. Conclusions: Undiagnosed COPD is relatively frequent in ACS patients with smoking history and a simple screening procedure including PEFR and RHSQ can be administered before hospital discharge to discriminate those at negligible risk of undiagnosed COPD (ClinicalTrials.gov, NCT02324660 ). Highlights: Concomitant chronic obstructive pulmonary disease (COPD) is a well-established determinant of poor prognosis in patients with ischemic heart disease (IHD) COPD is frequently undiagnosed in patients with IHD. In patients with acute coronary syndromes (ACS) we found undiagnosed COPD in the 29% of cases (95%CI 21%–36%). Our study is the first one trying to validate a simple, reproducible, quick test to screen undiagnosed COPD in ACS patients. The proposed screening is simple, safe, inexpensive and feasible just few days after the acute event. This simple screening applied by cardiologists might be sufficient to identify those patients with a negligible risk of concomitant undiagnosed COPD.