In a recent study in the New England Journal of Medicine, participants who were discovered to have undiagnosed chronic obstructive pulmonary disease (COPD) or asthma on spirometry were recruited to participate in a multicenter, randomized, controlled trial. The objective was to ascertain if early diagnosis and treatment with a pulmonologist-directed treatment strategy diminishes healthcare utilization for management of respiratory illness and enhances clinical outcomes.

The study trial, Undiagnosed COPD and Asthma Population (UCAP), was a combined case-finding study and randomized, controlled trial conducted from June 2017 through January 2024 at 17 sites in Canada.

Participants were aged 18 years and older and were surveyed whether they had respiratory symptoms during the previous 6 months. The participants who scored at least 6 on the Asthma Screening Questionnaire or at least 20 on the COPD Diagnostic Questionnaire were invited to undergo spirometry to confirm whether a diagnosis of asthma or COPD had gone undiagnosed.

The participants identified as having previously undiagnosed asthma or COPD were randomly assigned 1:1 to receive treatment from either 1) a trial pulmonologist and an asthma-COPD educator who were instructed to initiate guideline-based care (designated as the intervention group) or 2) their primary care practitioner (designated as the usual care group). The primary outcome was the annualized rate of participant-initiated healthcare use for respiratory illness at 1 year.

The study cohort consisted of 508 individuals who were identified as having undiagnosed COPD or asthma. Of those 508 patients, 253 were randomly assigned to the intervention group (mean [SD] age, 63.4 [13.4] years; 64% male) and 255 were assigned to the usual-care group (mean age, 62.8 [13.6] years; 58% male).

The results revealed that at 12 months, 232 participants (92%) in the intervention group and 153 (60%) in the usual-care group began a new treatment for asthma or COPD. The annualized rate of a primary outcome event was lesser in the intervention group when compared with the usual-care group (0.53 vs. 1.12 events per person-year; incidence rate ratio, 0.48; 95% CI, 0.36-0.63; P <.001). Additionally, the hospitalization rate was 0.021 per person-year for the intervention group and 0.030 per person-year for the usual-care group (incidence rate ratio, 0.71; 95% CI, 0.17-2.99), and the intervention group had a rate of emergency department visits of 0.069 per person-year compared with 0.075 per person-year in the usual-care group (incidence rate ratio, 0.92; 95% CI, 0.46-1.87).

The St. George Respiratory Questionnaire total score was lower than the baseline score by 10.2 points in the intervention group and 6.8 points in the usual-care group (difference, –3.5 points; 95% CI, –6.0 to –0.9). At 12 months, the total COPD Assessment Test score was lower than the baseline score by 3.8 points for the intervention group and 2.6 points for the usual-care group (difference, –1.3 points; 95% CI, –2.4 to –0.1).

The researchers reported that during follow-up, each group had two deaths. Regarding the incidence of adverse events, 24 were reported in 21 participants in the intervention group versus 16 adverse events in 14 participants in the usual-care group. The adverse events commonly observed were dizziness, syncope, or muscle cramping.

Based on their findings, the authors wrote, “The results showed that symptomatic persons with previously undiagnosed COPD or asthma who received treatment from a pulmonologist and asthma–COPD educator had less participant-initiated healthcare utilization for respiratory illness over a 1-year period than those who received usual care from their primary care practitioner. Both trial groups showed clinically important reductions in symptoms and improvements in disease-specific quality of life at 1 year. The results suggest that clinical care of persons with undiagnosed asthma or COPD was associated with health benefit, whether care was provided by a specialist or a primary care practitioner.”

The authors concluded that in this trial, in which a strategy was employed to identify adults in the community with undiagnosed asthma or COPD, those who obtained pulmonologist-directed treatment had lesser rates of subsequent healthcare utilization for respiratory illness than those who received usual care.

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