Screening older patients for obstructive airways disease in a semi-rural practice

Background-Obstructive airways disease in older patients is reported to be not only common, but frequently overlooked and untreated by general practit ioners. This study examines the value of screening elderly patients in a la rge semi-rural general practice for potentially treatable asthma and chroni c obstructive pulmonary disease (COPD). Methods-A random sample of 353 patients aged 60-75 years attended a nurse r un screening clinic for pulmonary function testing, serial peak flow record ing, and completion of a symptom questionnaire. Patients with a low forced expiratory volume in one second (below the fifth centile of their predicted value) or >15% mean diurnal variation in peak flow were referred to a doct or's clinic for further diagnostic assessment and/or to discuss possible tr eatment where appropriate. Results-Fifty eight patients (16.4%) had obstructive airways disease, the p revalence of asthma being 6.5% and that of COPD 9.9%. Of these, 30 had no p revious diagnosis of airways disease and were not on treatment; eight of th em had significant airways reversibility and 10 were current smokers. No ne wly diagnosed patients had severe disease as measured by pulmonary function or quality of life assessment, and six patients accepted treatment. Conclusion-Few older patients benefited from a screening programme for obst ructive airways disease in a semi-rural general practice.