This innovative Canadian study, published in the New England Journal of Medicine, marks a world first
Source: The Ottawa Hospital Research Institute (OHRI)
May 22, 2024
Finding and treating people with undiagnosed asthma or chronic obstructive pulmonary disease (COPD) improved their health and reduced their healthcare visits for respiratory symptoms in the year after diagnosis, according to a world-first clinical trial published in the New England Journal of Medicine. Led by Dr. Shawn Aaron at The Ottawa Hospital, the study was conducted in 17 study sites across Canada, including the Research Institute of the McGill University Health Centre (RI-MUHC).
"This study clearly outlines the large burden of untreated and undiagnosed asthma and COPD in the community. It also demonstrated, for the first time, that the diagnosis and treatment of asthma and COPD by specialist educators and pulmonologists reduces the number of healthcare visits, but most importantly improves both the overall health status and quality of life of individuals," says Dr. Nicole Ezer, co-author and principal investigator of the study at the RI-MUHC, who is a scientist at the Centre for Outcomes Research and Evaluation of the RI-MUHC and a respirologist at the MUHC.
How did the research team find undiagnosed cases?
To find people with undiagnosed asthma and COPD, the research team called random phone numbers in Canada from 2017 to 2023. An automated call asked whether any adults in the household had unexplained shortness of breath, wheezing, prolonged cough or were coughing up mucus in the past six months.
The 26,905 people who reported these symptoms completed questionnaires. Those most likely to have asthma or COPD did a spirometry breathing test - a test where patients blow in a machine to measure their lung function and that provides important information on how to treat breathing problems.
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.
Half the people in the trial were randomly assigned to usual care (care provided by their primary care provider or a walk-in-clinic), while the other half were treated by a lung specialist and asthma/COPD educator (a specially-trained nurse or respiratory therapist).
Individuals treated by a lung specialist and educator were prescribed inhalers to treat their asthma or COPD and were taught how to use them. 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.
Treating undiagnosed asthma, COPD leads to fewer healthcare visits
The researchers found that patients seen by a lung specialist and asthma/COPD educator averaged 0.53 healthcare visits per year for respiratory symptoms in the year after diagnosis, compared to 1.12 visits in the usual care group.
In addition, patients seen by a lung specialist and asthma/COPD educator saw their average score on the St. George's Respiratory Questionnaire rise by 10.2 points, compared to 6.8 points for the usual care group. A four-point rise means an improvement in health and quality of life.
"In the real world, not everyone can see a lung specialist," explains Dr. Aaron, a senior scientist and lung specialist at The Ottawa Hospital and professor at the University of Ottawa. "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."
“Patients shouldn’t have to put up with chronic breathing problems,” adds Dr. Ezer, who is also Assistant Professor in the Department of Medicine at McGill University. “I would encourage anyone who feels limited in their activities by shortness of breath to ask their health care provider about a spirometry test - the gold standard for diagnosis- if it hasn’t been done yet. This study shows that treatments and patient education are a winning combination.”
The RI-MUHC team involved in this study, including research assistant Francine Noel and respiratory nurse educator Cathy Fugere, would like to thank the Centre for Innovative Medicine for facilitating the smooth conduct of the clinical trial.
To learn more: read the full press release, including the testimonial of a research participant whose life improved after receiving an asthma diagnosis.
About the study
Early Diagnosis and Treatment of COPD and Asthma: A Randomized, Controlled Trial. Shawn D. Aaron, Katherine L. Vandemheen, G. A. Whitmore, Celine Bergeron, Louis-Philippe Boulet, Andreanne Cote, Andrew McIvor, Erika Penz, Stephen K. Field, Catherine Lemière, Irvin Mayers, Mohit Bhutani, Tanweer Azher, Diane Lougheed, Samir Gupta, Nicole Ezer, Christopher J. Licskai, Paul Hernandez, Martha Ainslie, Gonzalo G Alvarez, Sunita Mulpuru, for the UCAP investigators. New England Journal of Medicine. May 20, 2024.
This study was funded by the Canadian Institutes of Health Research.