World's first trial shows benefits of detecting and treating undiagnosed asthma and COPD

Finding and treating people with undiagnosed asthma or chronic obstructive pulmonary disease (COPD) improved their health and reduced the number of visits to health care for respiratory symptoms within a year of diagnosis, according to a world-first clinical study published in New England Journal of Medicine.

“An estimated 70% of people with asthma or COPD are not diagnosed,” the presenter said Study author Dr. Sean Aaron, senior research fellow and pulmonary specialist at The Ottawa Hospital and professor at the University of Ottawa. “This is the first study to show that treatment for these people significantly improves their health and quality of life.”

How did the research team identify undetected cases?

To identify people with undiagnosed asthma and COPD, the research team called random phone numbers at 17 study sites across Canada from 2017 to 2023. The automated call asked if any adults in the home had unexplained shortness of breath, wheezing, a persistent cough, or coughing up mucus in the past six months.

26,905 people who reported these symptoms completed questionnaires. Those who had a high likelihood of asthma or COPD underwent spirometric breathing testing, the gold standard for diagnosis.

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

Half of the people in the study were randomly assigned to usual care (treatment provided by their primary care physician or an urgent care clinic), while the other half were treated by a pulmonary specialist and asthma/COPD educator (specially trained nurse or respiratory therapist).

People treated by a pulmonary specialist and educator were prescribed inhalers for asthma or COPD and were taught how to use them. Some were given action plans to self-manage flare-ups. They also received smoking cessation treatment, exercise and weight counseling, and pneumonia and influenza vaccines if needed.

Of patients treated by a pulmonary specialist and educator, 92% started taking new medications for asthma or COPD, compared with 60% of patients receiving usual care.

Treating undiagnosed asthma and COPD leads to fewer health care visits

The researchers found that patients seen by a pulmonary specialist and educator had an average of 0.53 visits per year for respiratory symptoms in the year after diagnosis, compared with 1.12 visits in the usual care group.

Additionally, patients seen by a pulmonary specialist and educator had an average St. George Respiratory Questionnaire score increase of 10.2 points, compared with 6.8 points in the usual care group. A four-point increase means improved health and quality of life.

“In real life, not everyone can see a lung specialist,” explains Dr. Aaron. “The good news is that if a patient receives a diagnosis and treatment, their symptoms will improve. People in our study who went to primary care physicians and urgent care clinics had good results, and those who went to a specialist and teacher had excellent results.”

Study participant notes the importance of an asthma diagnosis

Jazminn Hein was 24 years old and had recently given birth to her first child when she received a call asking her to join the study. Several times carrying laundry up the stairs or talking on the phone for 10 minutes left her breathless. She saw no reason not to take the breath test.

“For years I told doctors about the feeling of an elephant on my chest and difficulty breathing. They said it was my anxiety, that I was having panic attacks,” recalls Jazminn.

But these were not panic attacks. It was asthma. Asthma, probably since elementary school. A daily inhaler changed her symptoms.

“A diagnosis of asthma is important,” she says. “Muscles need oxygen, and when you can’t breathe properly, it makes you tired and exhausted. I noticed an increase in energy. I now have two small children, and I can keep up with them. I sleep better because I used to constantly wake up short of breath.”

Asthma affects 8% of Canadian adults and can develop at any age, while COPD affects 8% of Canadians over 60.

“If you have symptoms like mine, go to your doctor or urgent care clinic and ask for a spirometry test,” recommends Jazminn. “The worst thing that can happen is wasting time. But if you have a respiratory illness and it's treated correctly, you can do things you never knew you missed."

Dr. Aaron agrees with Jazminn. He believes the best way to identify more cases of undetected asthma and COPD is for patients to seek diagnosis themselves. His past research has shown that even the early stages of these diseases are associated with poorer quality of life, more health care visits, and decreased work productivity.

“Many people know to ask for tests for breast and colorectal cancer when certain signs appear. Ideally, they would request a spirometry test when symptoms of chronic respiratory disease appear,” says Dr. Aaron. “People should not have to put up with breathing problems when there is effective treatment available.”