Trial Reveals Benefits of Diagnosing and Treating Hidden Asthma and COPD

A world-first clinical trial published in the New England Journal of Medicine found that identifying and treating individuals with undiagnosed asthma or chronic obstructive pulmonary disease (COPD) improved their health and decreased their visits to the doctor for respiratory symptoms in the year following diagnosis.

“It’s estimated that 70 per cent of people with asthma or COPD go undiagnosed.” said study lead Dr. Shawn Aaron, a senior scientist and lung specialist at The Ottawa Hospital and professor at the University of Ottawa. “This is the first study to prove that treating those people makes a real difference to their health and quality of life.”

How did the scientists locate patients that were undiagnosed?

From 2017 to 2023, the research team dialed random phone numbers at 17 study locations across Canada to discover adults with undiagnosed asthma and COPD. In the last six months, an automated call inquired as to whether any individuals living in the home had experienced persistent coughing, wheezing, unexplained shortness of breath, or mucus in their cough.

Questionnaires were filled out by the 26,905 persons who reported having these symptoms. Those most likely to have asthma or COPD did a spirometry breathing test, the gold standard for diagnosis.

A total of 595 people were diagnosed with either asthma or COPD, and 508 agreed to participate in a randomized controlled trial to compare different types of care.

A lung specialist and an asthma/COPD educator (a specially-trained nurse or respiratory therapist) treated half of the trial participants randomly, while the other half received routine care (care from their primary care physician or a walk-in clinic).

Patients receiving care from a lung expert and educator were given instructions on how to use inhalers and prescribed medication to manage their COPD or asthma. Some were given action plans to help them manage disease flare-ups themselves. They were provided with smoking cessation treatment, exercise and weight counselling, and pneumonia and flu vaccines if appropriate.

Ninety-two per cent of patients seen by a lung specialist and asthma/COPD educator started new medications for asthma or COPD, compared to 60 per cent of patients who received usual care.

Reducing undetected COPD and asthma results in fewer medical visits

In the year following diagnosis, patients treated by an asthma/COPD educator and lung specialist saw an average of 0.53 visits to the healthcare provider for respiratory symptoms, whereas the usual care group saw 1.12 visits.

Furthermore, the average score of patients who saw an asthma/COPD educator and lung specialist increased by 10.2 points on the St. George’s Respiratory Questionnaire, while the usual care group’s score only increased by 6.8 points. A four-point increase indicates better health and a higher standard of living.

“In the real world, not everyone can see a lung specialist,” explains Dr. Aaron. “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.”

For more information: Early Diagnosis and Treatment of COPD and Asthma: A Randomized, Controlled Trial, New England Journal of Medicine (2024). DOI: 10.1056/NEJMoa2401389