Screening for Chronic Obstructive Pulmonary Disease in Romanian Primary Care

Background and aims According to the World Health Organization chronic obstructive pulmonary disease (COPD) is the third leading cause of death worldwide and the seventh leading cause of poor health worldwide. Our aim was to evaluate the effectiveness of COPD screening strategy in Romanian primary care, comparing the diagnostic utility of the COPD Assessment Test (CAT) and the Modified Medical Research Council (mMRC) dyspnea scale and post-bronchodilator (post-BD) spirometry. Methods A cross-sectional screening study was conducted among 220 consecutive patients aged over 40 years. The study enrolled patients from the General Practitioner (GP) office. Demographics, clinical history, tobacco exposure, and validated screening questionnaires (CAT and mMRC) were recorded. All participants underwent diagnostic post-BD spirometry. Airflow limitation was defined as a post-BD FEV₁/FVC < 0.70. Results Spirometry confirmed a positive COPD diagnosis in 48.2% (n = 106) of the screened cohort. Severity staging revealed that 34.9% met criteria for GOLD 1, 49.1% for GOLD 2, 15.1% for GOLD 3, and 0.9% for GOLD 4. Smoking history (p < 0.001) was significantly higher in the COPD group. While the mMRC scale at a cut-off of ≥ 2 demonstrated excellent diagnostic specificity (82.5%) the CAT score ≥ 17 had 64.2% sensitivity and 74.8% specificity. Discussion The findings of this screening shows the clinical utility of primary care screening questionnaires. A comprehensive evaluation of symptoms—incorporating cough, sputum production, and sleep impact—provides a much more reliable clinical trigger for diagnostic spirometry than dyspnea alone. Conclusion A targeted screening protocol utilizing CAT score (≥ 17) has high diagnostic utility in Romanian primary care. Screening algorithms in primary care should be focused on individuals over 40 who present with a CAT score ≥ 17, or a tobacco history exceeding 20 pack-years.