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Background
Increasing concerns about Chronic obstructive pulmonary disease (COPD) are raised since it will be the fourth leading cause of deaths by 2030. Under diagnosis of COPD is a global problem, delaying adequate treatment and the possibility of preventing physical, emotional and socioeconomic consequences of the disease. Multiple attempts aimed at diagnosing COPD earlier but to date none really penetrated the primary care in western countries. Early detection of COPD is crucial for promoting smoking cessation – which is more or less the unique way to interfere with the natural history of the disease. The under diagnosis of COPD is mostly related to spirometry pitfalls which included- but not restricted to-physicians- and patients-related factors. The reasons for general practitioners (GP) not performing spirometry might be limited access to the equipment, lack of adequate training and time constraints. On the patients 'side, under diagnosis may be a result of the gradual adaptation to increasing shortness of breath due to declining lung function and a reluctance to seek for medical advice before severe symptoms occur. Moreover minor knowledge of the disease towards the general population leads to a non-discussion about shortness of breath: "Surrounding COPD is an historical nihilism, with patients and even their doctors establishing blame and blatantly denying a medical problem exists" was written in a review in 2009. Recently, the relative stability of the phenotype toward exacerbations rates identified a subgroup of COPD patients with a very low disease-related risk in terms of hospitalizations, exacerbation, accelerated decline in lung function or comorbidity. This fact did not help for persuading GPs that early COPD diagnosis is a worth effort. Questionnaires have been developed and more or less successfully developed but the issue raised by most GPs associations dealt with an unacceptable number of questionnaires that might be applied routinely for most chronic diseases.
Assessing exhaled carbon monoxide (eCO) concentration is routinely used in tobacco weaning programs for up to fifteen years. It was shown as a valuable noninvasive biomarker of cigarette smoke daily consumption which passed through most validation studies. As it stands, eCO is a 5 or 10 seconds measurement that responds to most issues related to any tool: easy to do, no contraindication, no expertise requirement, absolute harmlessness, low cost.
As cigarette smoking remains the main cause of COPD in western countries, we hypothesized that assessing eCO in primary care will help GPs to improve awareness about COPD that will introduce acceptance for a COPD screening. We assumed that eCO assessment in waiting rooms will improve the debate on smoking and COPD during medical consultations.
Accordingly, we aimed to test this hypothesis in primary care through a two-center randomized controlled trial.
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