Detection of Chronic Obstructive Pulmonary Disease by student nurses in primary health care: a pilot study

Introduction: Early detection of Chronic Obstructive Pulmonary Diseases (COPD) is the key for its control and management in Primary Health Care. Nurses could significantly contribute to the early detection of COPD if they receive appropriate training and develop skills such as performing spirometry tests and assess early COPD's signs and symptoms. Aim: To assess the ability of nursing students to detect undiagnosed cases of COPD through a designed spirometry program. Methods: Participants were approached following an open invitation by the local municipal authorities during January-June 2015 in 4 primary health care centres of the island of Crete, Greece. A screening program was conducted using two different diagnostic methods of COPD. All participants completed the International Primary Care Airways Guidelines' (IPAG) questionnaire, a validated instrument for COPD cases identification and performed a spirometry, a gold standard method for the diagnosis of COPD. Nursing students were trained for one month.Two different diagnoses of COPD were given using the interpretations of the spirometry tests and IPAG results for each individual participant (IPAG & GOLD standards). Diagnosis of COPD was based on the spirometry values using the GOLD recommendations(fixed ratio FEV1/FVC<70%). The capacity of nursing students in detecting COPD was based on the degree of agreement (Kappa test and ROC curve) between the two diagnoses of COPD (IPAG & GOLD). P-values <0.05 were considered statistically significant. Results: The mean age of the 390 participants was 55.6 (12.7) years old and 46.9% were male. The prevalence of COPD was 20% (78 cases) according to IPAG questionnaire and 12.1% (47 cases) according to spirometry. However, 31 cases of COPD that were detected using the IPAG, were classified as normal in spirometry, showing middle level of agreement (Kappa=0.71, p<0.001, 47/78 cases). Consequently, a sensitivity and specificity analysis was performed reported a sensitivity equal to 0.997, specificity equal to 0.397 and Curve ROC 0.842; CI: 0.767-0.909, p<0.001). Most of the COPD cases were classified as GOLD stages II and III (26/47 and 11/47, respectively). Conclusions: Our data suggest that nurses may significantly contribute to the early and accurate detection of COPD cases in primary healthcare if they receive a relevant COPD program. In addition, our findings highlight the necessity to establish “Respiratory Nursing” in Greece.