OBJECTIVE:Assess the impact in primary care of the 2025 Global Obstructive Lung Disease comment to use prebronchodilator results when they do not demonstrate obstruction. MATERIALS AND METHODS:Data from participants of the chronic obstructive pulmonary disease (COPD) Assessment in Primary Care To Identify Undiagnosed Respiratory Disease and Exacerbation study who had baseline pre- and postbronchodilator (BD) spirometry were used to assess the pre-BD results ability to predict post-BD obstruction, defined as forced expiratory volume in 1 second (FEV1)/forced vital capacity (FVC) <0.70. Spirometry data were stratified into 4 groups: (1) consistent nonobstruction, (2) only post-BD obstruction-missed diagnosis, (3) consistent obstruction, and (4) only pre-BD obstruction-over diagnosed. Sensitivity, specificity, and positive and negative predictive values of the pre-BD results to predict post-BD obstruction were calculated. RESULTS:A total of 1181 of 4336 participants (27.2%) were included in this study because they met the study's criteria for pre- and post-BD spirometry: pre-BD obstruction (FEV1/FVC <0.70) or FEV1 < 80% predicted. Of the 1181, 701 (59.4%) had consistent nonobstruction with 26 (2.2%) having only post-BD obstruction-missed diagnosis of COPD by pre-BD, whereas 273 (23.1%) had consistent obstruction. 181 (15.3% of the 1181 or 4.2% of the 4336) had only pre-BD obstruction-overdiagnosis of COPD. Pre-BD sensitivity for post-BD obstruction (labeled COPD) was 91.3% (95% CI, 87.5-94.2) with specificity 79.5% (95% CI, 76.7-82.1), negative predictive value 96.4% (95% CI, 94.8-97.7), and positive predictive value 60.1% (95% CI, 55.5-64.7). CONCLUSIONS:Using the 2025 Global Obstructive Lung Disease recommendations in these primary care patients with pre-BD spirometry showing obstruction or an FEV1 < 80% predicted resulted in few missed diagnoses of COPD or obstruction. Our data confirm that nonobstructive pre-BD results may be used routinely in primary care.

RATIONALE:Excess weight contributes to impaired physical function among individuals with chronic obstructive pulmonary disease (COPD) and sleep apnea. Self-directed lifestyle-based weight management programs are an accessible option to promote weight loss and improve physical function, but their effectiveness has not been clearly demonstrated. OBJECTIVE:To test whether a self-directed lifestyle program improves 6-minute walk test (6MWT) distance among individuals with COPD and comorbid sleep apnea. STUDY DESIGN AND METHODS:We performed a subset analysis of participants previously enrolled in the INSIGHT-COPD randomized clinical trial (low-intensity lifestyle intervention vs usual care) who self-reported a diagnosis of sleep apnea. Our primary outcome was between-group differences for change in 6MWT distance (minimally important difference [MID] 30 m). Secondary outcomes included between-group differences in weight (a loss of 3% defines meaningful reduction) and quality of life (SF-12 Physical Component Score [PCS], MID 3-3.5 points). We also tested whether sleep apnea modified the effect of the intervention across the entire INSIGHT-COPD population. MEASUREMENTS AND MAIN RESULTS:Among 285 participants with sleep apnea (141 randomly allocated to intervention, 144 to usual care), those randomized to intervention could walk further (difference in 6MWT distance of 25.5 m, 95% CI 8.2 m to 42.9 m; 23.4% vs 20.1% had a MID increase in 6MWT distance) and had a greater reduction in weight (difference in weight of -2.4 kg, 95% CI -3.9 to -0.9 kg; 36.2% vs 23.6% had a 3% reduction in weight) at 12 months. The intervention group also reported a greater physical-function-related quality of life (difference in SF-12 PCS of 1.78 pts, 95% CI 0.10 to 3.49) in comparison to usual care at 12 months. CONCLUSIONS:Among patients with COPD and sleep apnea, a self-directed video-based weight management program led to favorable changes in 6MWT distance compared to usual care, though this did not meet the threshold of a clinically important improvement. However, fewer participants in the intervention group saw a decline in 6MWT distance, and more achieved meaningful weight loss. To effectively improve function in this population, additional interventions beyond self-directed weight management will be necessary.Clinical trial registered with www.clinicaltrials.gov (NCT02634268).

Rationale: The impact of screening for chronic obstructive pulmonary disease (COPD) on U.S. primary care clinician behavior and patient outcomes is unclear. Objectives: We sought to assess the impact of receiving screening scores for clinical and patient outcomes using the COPD Assessment in Primary Care To Identify Undiagnosed Respiratory Disease and Exacerbation Risk (CAPTURE) tool. Methods: This cluster-randomized trial included 49 usual-care (COPD education only) and 51 intervention (COPD and CAPTURE education plus screening scores) primary care practices. Twelve-month medical record and patient survey outcome data were collected from patients with elevated screening scores or study spirometric abnormalities. Measurements and Main Results: Among 387 CAPTURE screen-positive (CAPTURE+) patients, no significant difference was noted between usual-care and intervention practices in the primary composite outcomes of 1) spirometry referral/completion, or 2) new COPD diagnosis, or 3) newly prescribed inhaled long-acting respiratory medication, or 4) referral to a respiratory specialist, or 5) pulmonary rehabilitation referral/completion; 45.9% versus 41.9%, respectively (absolute difference, 4.0%; 95% confidence interval, -6.9, 15.0; P = 0.47). Only spirometry referral/completion was higher in the intervention group (absolute difference, 10.4%; 95% confidence interval, 0.1, 20.7; P = 0.0465). No differences were noted for secondary outcomes, composite components, change in COPD Assessment Test scores, rates of respiratory illnesses, or hospitalizations. For the 1,028 CAPTURE screen-negative (CAPTURE-) patients, composite primary and all secondary outcomes were similar in the two arms. In secondary and post hoc analyses evaluating the potential impact of the pandemic, intervention group differences in clinician and patient outcomes were noted for CAPTURE+ and CAPTURE- patients in the prepandemic period that diminished during the pandemic. Conclusions: Within these U.S. primary care practices, COPD and CAPTURE education plus receipt of CAPTURE screening scores did not change clinician COPD assessment or care or patient outcomes for CAPTURE+ patients. However, in the prepandemic period, CAPTURE+ patients were more likely to undergo spirometry referral completion, whereas for CAPTURE- patients, clinicians were significantly less likely to assess for COPD, suggesting that the intervention resulted in a more appropriate use of healthcare resources. Clinical trial registered with www.clinicaltrials.gov (NCT03581227).

Background:The burden of chronic obstructive pulmonary disease (COPD) is well established, but opportunities for earlier diagnosis and improved management are still missed. Compared to the general COPD population, patients with a history of exacerbations and suboptimal treatment ("modifiable high-risk") are at greater risk of future exacerbations and adverse health outcomes. To date there is no systematic approach for identifying and treating this patient group. Method:Two cluster randomized controlled trials (CRTs) in the United Kingdom and United States will assess the impact of a primary care-based quality improvement program (COllaboratioN on QUality improvement initiative for achieving Excellence in STandards of COPD care [CONQUEST]), compared to routine care. In each trial, 126 primary care clusters will be randomized 1:1 to intervention or control arms. Three groups of modifiable high-risk patients will be identified using electronic medical records: undiagnosed with potential COPD, newly diagnosed COPD, and already diagnosed COPD. Eligible patients will be aged ≥40 years, have experienced ≥2 moderate/≥1 severe exacerbation(s) in the prior 24 months, including ≥1 in the last 12 months, and not be prescribed inhaled triple therapy. Patients in the undiagnosed group will also be required to have a positive smoking history. Primary trial outcomes will be the annual rate of exacerbations and the annual rate of major adverse cardiac or respiratory events, comparing the quality improvement program against routine care. Discussion:These will be the first CRTs assessing such a comprehensive primary care-based COPD quality improvement program. Intention-to-treat analysis of trial outcomes after 24 months will inform its effectiveness in targeting the identification, assessment, treatment, and follow-up of patients with modifiable high-risk COPD. Trial registration:UK trial: ISRCTN15819828; US trial: NCT05306743.

BACKGROUND:Quality improvement programmes (QIPs) are designed to enhance patient outcomes by systematically introducing evidence-based clinical practices. The CONQUEST QIP focuses on improving the identification and management of patients with COPD in primary care. The process of developing CONQUEST, recruiting, preparing systems for participation, and implementing the QIP across three integrated healthcare systems (IHSs) is examined to identify and share lessons learned. APPROACH AND DEVELOPMENT:This review is organized into three stages: 1) development, 2) preparing IHSs for implementation, and 3) implementation. In each stage, key steps are described with the lessons learned and how they can inform others interested in developing QIPs designed to improve the care of patients with chronic conditions in primary care.Stage 1 was establishing and working with steering committees to develop the QIP Quality Standards, define the target patient population, assess current management practices, and create a global operational protocol. Additionally, potential IHSs were assessed for feasibility of QIP integration into primary care practices. Factors assessed included a review of technological infrastructure, QI experience, and capacity for effective implementation.Stage 2 was preparation for implementation. Key was enlisting clinical champions to advocate for the QIP, secure participation in primary care, and establish effective communication channels. Preparation for implementation required obtaining IHS approvals, ensuring Health Insurance Portability and Accountability Act compliance, and devising operational strategies for patient outreach and clinical decision support delivery.Stage 3 was developing three IHS implementation models. With insight into the local context from local clinicians, implementation models were adapted to work with the resources and capacity of the IHSs while ensuring the delivery of essential elements of the programme. CONCLUSION:Developing and launching a QIP programme across primary care practices requires extensive groundwork, preparation, and committed local champions to assist in building an adaptable environment that encourages open communication and is receptive to feedback.

"Impact of the SARS-CoV-2 Pandemic on Outcomes of CAPTURE; a Primary Care COPD Screening Study." Annals of the American Thoracic Society, 0(ja), pp.

Background In this study, we compare management of patients with high-risk chronic obstructive pulmonary disease (COPD) in the United States to national and international guidelines and quality standards, including the COllaboratioN on QUality improvement initiative for achieving Excellence in STandards of COPD care (CONQUEST). Methods Patients were identified from the DARTNet Practice Performance Registry and categorized into three high-risk cohorts in each year from 2011 to 2019: newly diagnosed (& LE;12 months after diagnosis), already diagnosed, and patients with potential undiagnosed COPD. Patients were considered high-risk if they had a history of exacerbations or likely exacerbations (respiratory consult with prescribed medication). Descriptive statistics for 2019 are reported, along with annual trends.Findings In 2019, 10% (n = 16,610/167,197) of patients met high-risk criteria. Evidence of spirometry for diagnosis was low; in 2019, 81% (n = 1228/1523) of patients newly diagnosed at high-risk had no record of spirometry/peak expiratory flow in the 12 months pre-or post-diagnosis and 43% (n = 651/1523) had no record of COPD symptom review. Among those newly and already diagnosed at high-risk, 52% (n = 4830/9350) had no evidence of COPD medication.Interpretation Findings suggest inconsistent adherence to evidence-based guidelines, and opportunities to improve identification, documentation of services, assessment, therapeutic intervention, and follow-up of patients with COPD.

Background: Most of our COPD knowledge comes from studies of older individuals. We must examine milder disease in younger patients if we are to better understand COPD pathogenesis. Aim: Describe the respiratory disease burden among young and middle-aged adults at risk for or with COPD. Methods: MAP COPD (goal n=200) is a partnership between the COPD Foundation and the University of Michigan to establish an early COPD cohort. SOURCE (goal n=650) is an NHLBI-funded early COPD cohort recruiting across 12 US centers in the SPIROMICS network. Enrollment criteria for both studies include age 30-55 years and smoking history ≥10 pack years. All participants undergo baseline spirometry, high resolution CT (HRCT) of the chest, blood biomarker analysis and symptom assessment using the Chronic Airways Assessment Test (CAAT), a modification of the COPD Assessment Test. Results: We report initial results from 109 MAP COPD and 70 co-enrolled SOURCE participants at the University of Michigan. Mean age was 47.3 years, 53.2% of participants were female and 57.8% were currently smoking. Mean CAAT score was high in all spirometry groups: 11.4 in GOLD 0 (n=87), 12.5 in PRISm (n=8), 11.0 in GOLD 1 (n=2) and 15.8 in GOLD 2 (n=12). For alpha-1 antitrypsin, 7.8% of participants had a phenotype other than MM. On visual inspection of HRCTs, 39.8% had emphysema (39.5% of GOLD 0, 25.0% of PRISm; most with a centrilobular pattern), 39.8% one or more non-calcified lung nodules, 11.1% gas trapping and 9.3% respiratory bronchiolitis. Conclusion: High respiratory symptom burden and evidence of emphysema on CT were prevalent in individuals with a smoking history and early COPD, including those without spirometric airflow obstruction.

Importance:Chronic obstructive pulmonary disease (COPD) is underdiagnosed in primary care. Objective:To evaluate the operating characteristics of the CAPTURE (COPD Assessment in Primary Care To Identify Undiagnosed Respiratory Disease and Exacerbation Risk) screening tool for identifying US primary care patients with undiagnosed, clinically significant COPD. Design, Setting, and Participants:In this cross-sectional study, 4679 primary care patients aged 45 years to 80 years without a prior COPD diagnosis were enrolled by 7 primary care practice-based research networks across the US between October 12, 2018, and April 1, 2022. The CAPTURE questionnaire responses, peak expiratory flow rate, COPD Assessment Test scores, history of acute respiratory illnesses, demographics, and spirometry results were collected. Exposure:Undiagnosed COPD. Main Outcomes and Measures:The primary outcome was the CAPTURE tool's sensitivity and specificity for identifying patients with undiagnosed, clinically significant COPD. The secondary outcomes included the analyses of varying thresholds for defining a positive screening result for clinically significant COPD. A positive screening result was defined as (1) a CAPTURE questionnaire score of 5 or 6 or (2) a questionnaire score of 2, 3, or 4 together with a peak expiratory flow rate of less than 250 L/min for females or less than 350 L/min for males. Clinically significant COPD was defined as spirometry-defined COPD (postbronchodilator ratio of forced expiratory volume in the first second of expiration [FEV1] to forced vital capacity [FEV1:FVC] <0.70 or prebronchodilator FEV1:FVC <0.65 if postbronchodilator spirometry was not completed) combined with either an FEV1 less than 60% of the predicted value or a self-reported history of an acute respiratory illness within the past 12 months. Results:Of the 4325 patients who had adequate data for analysis (63.0% were women; the mean age was 61.6 years [SD, 9.1 years]), 44.6% had ever smoked cigarettes, 18.3% reported a prior asthma diagnosis or use of inhaled respiratory medications, 13.2% currently smoked cigarettes, and 10.0% reported at least 1 cardiovascular comorbidity. Among the 110 patients (2.5% of 4325) with undiagnosed, clinically significant COPD, 53 had a positive screening result with a sensitivity of 48.2% (95% CI, 38.6%-57.9%) and a specificity of 88.6% (95% CI, 87.6%-89.6%). The area under the receiver operating curve for varying positive screening thresholds was 0.81 (95% CI, 0.77-0.85). Conclusions and Relevance:Within this US primary care population, the CAPTURE screening tool had a low sensitivity but a high specificity for identifying clinically significant COPD defined by presence of airflow obstruction that is of moderate severity or accompanied by a history of acute respiratory illness. Further research is needed to optimize performance of the screening tool and to understand whether its use affects clinical outcomes.

Background:E-cigarette or vaping-use related acute lung injury (EVALI) is a spectrum of radiographic and histologic patterns consistent with acute to subacute lung injury. However, limited data exist characterizing bronchoalveolar lavage (BAL) findings. The goal of this study is to further define the pathologic findings from BAL and biopsy samples of subjects with EVALI across 7 institutions. Methods:A multicentered registry of patients admitted with EVALI who underwent flexible bronchoscopy with BAL+/-transbronchial biopsy from July 2019 to April 2021 was compiled for retrospective evaluation from 7 academic institutions throughout the United States. Radiographic and cytopathologic findings and frequencies were correlated with the substance vaped. Results:Data from 21 subjects (42.9% women) who were predominantly White (76.2%) with a median age of 25 years (range, 16 to 68) with EVALI were included in this study. Sixteen patients (76.2%) reported use of tetrahydrocannabinol; the remainder used nicotine. BAL was performed in 19 of the 21 subjects, and transbronchial lung biopsy was performed in 7 subjects. BAL findings revealed neutrophilic predominance (median, 59.5%, range, 3.1 to 98) in most cases. Ten BAL samples demonstrated pulmonary eosinophilia ranging from 0.2% to 49.1% with one subject suggesting a diagnosis of acute eosinophilic pneumonia associated with the use of e-cigarettes. Lipid-laden macrophages were noted in 10 of 15 reports (66.7%). Transbronchial biopsy most frequently demonstrated patterns of organizing pneumonia (57.1%). Conclusion:EVALI-associated BAL findings typically demonstrate a spectrum of nonspecific inflammatory changes, including neutrophilia, lipid-laden macrophages, and in some cases eosinophilia.

BACKGROUND:Many persons with a history of smoking tobacco have clinically significant respiratory symptoms despite an absence of airflow obstruction as assessed by spirometry. They are often treated with medications for chronic obstructive pulmonary disease (COPD), but supporting evidence for this treatment is lacking.METHODS:We randomly assigned persons who had a tobacco-smoking history of at least 10 pack-years, respiratory symptoms as defined by a COPD Assessment Test score of at least 10 (scores range from 0 to 40, with higher scores indicating worse symptoms), and preserved lung function on spirometry (ratio of forced expiratory volume in 1 second [FEV1] to forced vital capacity [FVC] ≥0.70 and FVC ≥70% of the predicted value after bronchodilator use) to receive either indacaterol (27.5 μg) plus glycopyrrolate (15.6 μg) or placebo twice daily for 12 weeks. The primary outcome was at least a 4-point decrease (i.e., improvement) in the St. George's Respiratory Questionnaire (SGRQ) score (scores range from 0 to 100, with higher scores indicating worse health status) after 12 weeks without treatment failure (defined as an increase in lower respiratory symptoms treated with a long-acting inhaled bronchodilator, glucocorticoid, or antibiotic agent).RESULTS:A total of 535 participants underwent randomization. In the modified intention-to-treat population (471 participants), 128 of 227 participants (56.4%) in the treatment group and 144 of 244 (59.0%) in the placebo group had at least a 4-point decrease in the SGRQ score (difference, -2.6 percentage points; 95% confidence interval [CI], -11.6 to 6.3; adjusted odds ratio, 0.91; 95% CI, 0.60 to 1.37; P = 0.65). The mean change in the percent of predicted FEV1 was 2.48 percentage points (95% CI, 1.49 to 3.47) in the treatment group and -0.09 percentage points (95% CI, -1.06 to 0.89) in the placebo group, and the mean change in the inspiratory capacity was 0.12 liters (95% CI, 0.07 to 0.18) in the treatment group and 0.02 liters (95% CI, -0.03 to 0.08) in the placebo group. Four serious adverse events occurred in the treatment group, and 11 occurred in the placebo group; none were deemed potentially related to the treatment or placebo.CONCLUSIONS:Inhaled dual bronchodilator therapy did not decrease respiratory symptoms in symptomatic, tobacco-exposed persons with preserved lung function as assessed by spirometry. (Funded by the National Heart, Lung, and Blood Institute and others; RETHINC ClinicalTrials.gov number, NCT02867761.).

Individuals with current or former smoking history who have respiratory symptoms despite lack of spirometric airflow obstruction experience significant morbidity. They are often treated with COPD medications without supporting evidence. We randomized 535 participants with ≥10 pack-years smoking history, respiratory symptoms defined by COPD Assessment Test (CAT) score ≥10, and preserved spirometry (post-bronchodilator FEV1 /FVC ≥0.70) to indacaterol/glycopyrrolate 27.5/15.6 mcg inhalation or blinded placebo twice daily for twelve weeks. The primary outcome was proportion with a ≥4-unit improvement in SGRQ score without treatment failure (defined as an increase in lower respiratory symptoms treated with long-acting inhaled bronchodilator, corticosteroids, or antibiotics). In the modified intention to treat analysis (n=471), 128 (56.4%) versus 144 participants (59.0%) in the intervention and control groups, respectively, achieved the primary outcome (difference, -2.6%; 95% confidence interval [CI], -11.6 to 6.3%; adjusted odds ratio 0.91; 95% CI, 0.60 to 1.37; p=0.65). The change in FEV1 (% predicted) was 2.48 (95% CI, 1.49 to 3.47) in the intervention group and -0.09 (95% CI, -1.06 to 0.89) in the placebo group; the change in inspiratory capacity (L) was 0.12 (95% CI, 0.07 to 0.18) in the intervention group and 0.02 (95% CI, -0.03 to 0.08) in the placebo group, respectively. Inhaled dual bronchodilator therapy did not improve respiratory symptoms in symptomatic, tobacco-exposed persons with preserved spirometry.

PURPOSE:The importance of the COVID-19 pandemic for the health of selected populations is being studied and described but little data exists from primary care populations not selected due to specific types of diagnoses, symptoms or surveillance screening.During the NIH funded COPD screening study, CAPTURE, we collected respiratory symptom data at baseline and relevant COVID-19 testing, infection, and recovery results at 12 month follow up.Our objective was to describe COVID-19 infection and recovery rates among this primary care population not diagnosed with COPD stratified by baseline respiratory symptoms.METHODS: 871 individuals recruited from primary care practices between March 15, 2020 and December 31, 2020.All completed baseline data and 77% (N¼668) completed 12 month follow up.Demographic and clinical data from the 668 s were summarized using means and standard deviations for continuous variables and frequencies with proportions for categorical variables.For questions of confirmed or suspected infections, complete recovery rates and time to recovery, results were compared for those with COPD Assessment Test (CAT) scores < or $10 using risk ratios.CAT scores were used as a proxy for respiratory symptom burden at baseline. RESULTS:Of the 668 participants, 418 (63%) were female, 437 (65%) were white, 340 (51%) had higher respiratory burden or CAT scores $ 10 at baseline.There were 80 (12%) suspected or confirmed COVID-19 cases of whom were tested and 6 (12%) had a positive test result, 4 (0.6%) were hospitalized and 2 (0.3%) had ICU stays.Among the 80 participants with confirmed or suspected COVID-19, 50 (63%) were completely recovered by the time of survey completion with an average time to recovery of 18 days (SD 18.2).The most commonly experienced symptoms in confirmed or suspected cases were cough (N¼33, 42%), fatigue (N¼30, 39%), and shortness of breath (N¼30, 39%).Participants with CAT scores $ 10 were at increased risk of reporting suspected or confirmed COVID-19 [52 (15%) vs 28 (8%), RR = 1.9 (1.2-3.0)], were less likely to report complete recovery [29 (56%) vs 21 (81%), RR 4.4 (1.1-17.4)]but not significantly more likely to have complete recovery times of > 2 weeks.Testing for COVID-19 was more common in those with a history of asthma vs those without (N¼45, 40% vs N¼159, 29%) and in those with a history of inhaler use vs those without (N¼49, 37% vs N¼155, 29%).COVID-19 testing varied over time with a steady increase from July to November 2020 before decreasing in December.CONCLUSIONS: Suspected cases were much higher than confirmed cases with testing rates highest in the fall and winter surge.Hospitalization rates were low but reported recovery required a mean of almost 3 weeks.Primary care populations, especially those with baseline respiratory burden (CAT $ 10) were at increased risk of suspected or confirmed COVID-19 and incomplete recovery.CLINICAL IMPLICATIONS: PC populations also experience COVID-19 with extended recovery periods.

Chronic obstructive pulmonary disease (COPD) often remains undiagnosed and untreated. To date, COPD screening/case finding has not been designed to identify clinically significant COPD, disease ready for therapies beyond smoking cessation. Herein, we describe the ongoing prospective, pragmatic cluster-randomized controlled trial to assess specificity and sensitivity of the COPD Assessment in Primary Care To Identify Undiagnosed Respiratory Disease and Exacerbation Risk (CAPTURE) tool consisting of 5 questions and peak expiratory flow. The tool is designed to identify clinically significant COPD (forced expiratory volume in 1 second [FEV1] to forced vital capacity [FVC] ratio <.70 plus FEV1% predicted <60% or increased risk for exacerbation) and the trial will explore the impact of CAPTURE-based screening on COPD diagnosis and treatment rates in primary care patients. Of a total planned enrollment of 5000 English- or Spanish-speaking patients 45 to 80 years of age without a prior COPD diagnosis from 100 primary care practices, a total of 68 practices and 3064 patients have been enrolled in the study. Practices are centrally randomized to either usual care or clinician receipt of patient-level CAPTURE results. All clinicians receive basic COPD education with those in intervention practices also receiving CAPTURE interpretation education. In a single visit, patient participants complete a CAPTURE screening, pre- and post-bronchodilator spirometry and baseline demographic and health questionnaires to validate CAPTURE sensitivity, specificity, and predictive value of identifying undiagnosed, clinically significant COPD. One-year follow-up chart reviews and participant surveys assess the impact of sharing versus not sharing CAPTURE results with clinicians on clinical outcomes including level of respiratory symptoms and events and clinicians' initiation of recommendation-concordant COPD care. This is one of the first U.S. studies to validate and assess impact of a simple COPD screening tool in primary care.