Early asthma and COPD intervention decreases healthcare utilization

1. In this randomized controlled trial, adults with undiagnosed asthma or chronic obstructive pulmonary disease (COPD) who received pulmonologist-directed treatment had lower healthcare utilization than those who received usual care.

2. Adults with undiagnosed asthma or COPD who received pulmonologist-directed treatment had improved secondary outcomes, including quality of life, symptom burden, and forced expiratory volume in 1 second (FEV1).

Evidence Rating Level: 1 (Excellent)

Study Rundown: Asthma and COPD are chronic airway diseases characterized by expiratory airflow obstruction and similar respiratory symptoms, including dyspnea, cough, and wheezing. Despite the significant global prevalence of asthma and COPD, especially in low- and middle-income countries, a significant volume of cases remain undetected, underestimating their global health burden. The identification of patients with undiagnosed asthma and COPD may allow for strategies to mitigate disease progression, more effective management of symptoms, and a reduction in the incidence of exacerbations. This trial used a case-finding strategy to identify symptomatic patients with undiagnosed asthma and COPD. It investigated whether early diagnosis and pulmonologist-directed treatment, including evaluation by a pulmonologist and an asthma-COPD educator, reduced healthcare utilization for respiratory illness compared to usual care by their primary care practitioner. Overall, it showed that adults with undiagnosed asthma and COPD who received pulmonologist-directed treatment had less respiratory-based healthcare utilization than those who received usual care. Adults with undiagnosed asthma or COPD who received pulmonologist-directed treatment also had improved secondary outcomes, including quality of life and symptom burden. The incidence of adverse events was similar between those who received pulmonologist-directed care and usual care. The trial population encompassed a high volume of older adults, limiting the generalizability of the study findings to younger populations.

Click to read the study in NEJM

In-Depth [randomized controlled trial]: UCAP (Undiagnosed COPD and Asthma Population) is a combined case study and randomized controlled trial to identify symptomatic adults with undiagnosed asthma or COPD and determine whether early diagnosis and treatment reduced healthcare utilization for respiratory illness. A commercial survey initially recruited participants who were 18 or older and had relevant respiratory symptoms within the past 6 months. Of these participants, those with a higher suspicion of asthma or COPD based on relevant questionnaires underwent spirometry. Participants whose spirometry results confirmed a diagnosis of asthma or COPD were randomly assigned in a 1:1 ratio to either receive treatment from a pulmonologist and an asthma-COPD educator (intervention group) or by their primary care practitioner (usual-care group). The trial’s primary outcome was the annualized rate of participant-initiated respiratory-based healthcare utilization during a 1-year follow-up period. Secondary outcomes included changes in quality of life and FEV1 over one year. Of the 38353 persons interviewed, 595 had undiagnosed asthma or COPD, and 508 participants underwent randomization. The annualized rate of healthcare utilization through 12 months was lower in the intervention group than in the usual-care group (0.53 vs. 1.12 events per person-year; incidence rate ratio, 0.48; 95% confidence interval [CI], 0.36 to 0.63; p<0.001). In terms of secondary outcomes, the SGRQ score was lower than baseline 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), the CAT score was lower than baseline by 3.8 points and 2.6 points respectively (difference, -1.3 points; 95% CI, -2.4 to -0.1), and the prebronchodilator FEV1 increased from baseline by 119 ml and 22 ml respectively (difference, 94 ml; 95% CI, 50 to 138). The incidence of adverse events was similar in both groups. In summary, this trial demonstrated that adults with undiagnosed asthma or COPD who received pulmonologist-directed treatment had less respiratory-based healthcare utilization than those who received usual care.

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