[General practice patients at risk of chronic obstructive pulmonary disease: epidemiologic survey of 3 411 patients].

OBJECTIVES:Describe patients at risk of chronic obstructive pulmonary disease (COPD) and analyze general practitioners' (GPs) management of COPD patients in France in 2003-2004. METHODS:EDEN, a national epidemiological survey, recruited 2 378 GPs. Each GP was to include 3 consecutive patients (aged 36-80 years) who were current or former smokers and presented respiratory symptoms (any of expectoration, cough, or dyspnea) without asthma or previously diagnosed COPD. The physician completed a standardized, anonymous questionnaire for each patient, including measurement of peak expiratory flow (PEF). RESULTS:The sample of 3 411 current smokers or former smokers with respiratory symptoms included twice as many men as women. The mean age was 58 years, with women significantly younger (p<0.0001). Men and older patients had more severe disease. Women were more often current smokers, but they smoked less than men. All patients had at least one respiratory symptom, but only 63.5% were seeing their GP for that reason. Overall, 56.5% patients reported repeated acute bronchitis, and 36.3% of these at least 3 episodes. PEF was measured in 87.7% of patients and the ratio of mean measured PEF/predicted PEF was 73.2%. GPs concluded that 92.1% of these patients had COPD, but prescribed respiratory function tests useful for only 73.8% and referred only 71.2% to a specialist. CONCLUSION:Former and current smokers underestimated their respiratory symptoms, and so did the GPs. Accordingly, COPD is diagnosed later and at a more advanced stage. Increasing GPs' awareness of COPD would improve early detection in at-risk subjects.