{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T21:07:13Z","timestamp":1792789633710,"version":"4.5.0"},"reference-count":17,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T00:00:00Z","timestamp":1789948800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"VICTOR BABES UNIVERSITY OF MEDICINE AND PHARMACY TIMISOARA","id":[{"id":"https:\/\/ror.org\/00afdp487","id-type":"ROR","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: Chronic obstructive pulmonary disease (COPD) is one of the leading causes of death worldwide and represents a major contributor to the global burden of disease. According to the World Health Organization it 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 active case finding of COPD in Romanian primary care through the COPD Assessment Test (CAT) and the Modified Medical Research Council (mMRC) dyspnea scale and post-bronchodilator (post-BD) spirometry. Materials and Methods: A prospective active case-finding study was conducted among 220 proactively selected patients with an age over 40 years and a documented history of at least one major respiratory risk factor. The study enrolled patients from one General Practitioner (GP) office. The exclusion criteria were malignancies and previously diagnosed obstructive disease. Demographics, tobacco exposure, clinical history and validated case-finding questionnaires (CAT and mMRC) were recorded. All participants underwent diagnostic post-bronchodilator spirometry. Airflow limitation was defined as a post-bronchodilator FEV1\/FVC &lt;0.70. The statistical analysis was performed with The Statistical Package for the Social Sciences version 27 (SPSS, Chicago, IL, USA). Results: Spirometry confirmed a positive COPD diagnosis in 48.2% (n = 106) of the study cohort. Severity staging revealed that 34.9% met criteria for GOLD 1 (Mild), 49.1% for GOLD 2 (Moderate), 15.1% for GOLD 3 (Severe), and 0.9% for GOLD 4 (Very Severe). Smoking history (p &lt; 0.001) was significantly higher in the COPD group. While the mMRC scale at a cut-off \u22652 demonstrated excellent diagnostic specificity (82.5%), its low sensitivity (41.5%) means that relying solely on breathlessness in primary care questionnaires would result in missing probably more than half of the patients with a positive diagnosis. In contrast, the CAT score at a threshold \u226517 offers a more balanced trade-off (64.2% sensitivity, 74.6% specificity) for active case finding of COPD patients. Discussion: The findings of this study acknowledge the clinical utility of using validated questionnaires in active case finding of COPD in Romanian primary care. A comprehensive evaluation of symptoms\u2014incorporating cough, sputum production, and sleep impact\u2014provides a much more reliable clinical trigger for diagnostic spirometry than dyspnea alone. While tobacco smoking remains the predominant driver of airflow limitation in our cohort, the identification of obstruction in 4.7% of never-smokers acknowledges the clinical necessity of accounting for non-smoking risk factors, occupational dust, environmental exposures and documented histories of recurrent winter bronchitis, persistent morning cough, or unexplained sputum production. In the study cohort, a CAT score \u226517 showed the best observed balance between sensitivity and specificity; this threshold should be considered cohort-specific and requires external validation before being adopted as a universal screening cut-off. This study had limitations, including the small, single-center sample size, which may limit generalization to the Romanian population. Conclusions: The results support the implementation of a targeted active case-finding strategy in Romanian primary care. These findings support further evaluation of targeted case-finding strategies incorporating symptom burden and smoking exposure as well as algorithms like spirometry on individuals over 40 who present with a CAT score \u2265 17, or a tobacco history.<\/jats:p>","DOI":"10.3390\/medicina62091820","type":"journal-article","created":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T16:06:51Z","timestamp":1790006811000},"page":"1820","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Active Case Finding of Chronic Obstructive Pulmonary Disease in Romanian Primary Care"],"prefix":"10.3390","volume":"62","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-4467-1477","authenticated-orcid":false,"given":"Andreea Narcisa","family":"Iana","sequence":"first","affiliation":[{"name":"Family Clinic, Center of Preventive Medicine, University of Medicine and Pharmacy Victor Babes, 300023 Timi\u0219oara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniela","family":"Gurgus","sequence":"additional","affiliation":[{"name":"Family Clinic, Center of Preventive Medicine, University of Medicine and Pharmacy Victor Babes, 300023 Timi\u0219oara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"validation","vocabulary":"credit"},{"role":"data-curation","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"visualization","vocabulary":"credit"}]},{"given":"Roxana","family":"Folescu","sequence":"additional","affiliation":[{"name":"Family Clinic, Center of Preventive Medicine, University of Medicine and Pharmacy Victor Babes, 300023 Timi\u0219oara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"software","vocabulary":"credit"},{"role":"validation","vocabulary":"credit"},{"role":"data-curation","vocabulary":"credit"},{"role":"visualization","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"supervision","vocabulary":"credit"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,21]]},"reference":[{"key":"ref_1","unstructured":"Global Burden of Disease Collaborative Network (2025). Global Burden of Disease 2023: Findings from the GBD 2023 Study, Institute for Health Metrics and Evaluation (IHME)."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"658A","DOI":"10.1378\/chest.1389539","article-title":"Prevalence of chronic obstructive pulmonary disease (COPD) in Romania","volume":"142","author":"Nemes","year":"2012","journal-title":"Chest"},{"key":"ref_3","unstructured":"GOLD (2026). Global Strategy for the Diagnosis, Management and Prevention of COPD, Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2026, GOLD. Available online: https:\/\/goldcopd.org."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Jones, P.W., Tabberer, M., and Chen, W.-H. (2011). Creating scenarios of the impact of COPD and their relationship to COPD Assessment Test (CAT\u2122) scores. BMC Pulm. Med., 11.","DOI":"10.1186\/1471-2466-11-42"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1511","DOI":"10.2147\/COPD.S413969","article-title":"Current Progress of COPD Early Detection: Key Points and Novel Strategies","volume":"18","author":"Lin","year":"2023","journal-title":"Int. J. Chronic Obstr. Pulm. Dis."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"106917","DOI":"10.1016\/j.rmed.2022.106917","article-title":"Disease burden in individuals with symptomatic undiagnosed asthma or COPD","volume":"200","author":"Alhabeeb","year":"2022","journal-title":"Respir. Med."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"995","DOI":"10.2147\/COPD.S195382","article-title":"Impact of COPD diagnosis timing on clinical and economic outcomes: The Arctic observational cohort study","volume":"14","author":"Larsson","year":"2019","journal-title":"Int. J. Chronic Obstr. Pulm. Dis."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1729","DOI":"10.2147\/COPD.S255414","article-title":"Clinical impact and healthcare resource utilization associated with early versus late COPD diagnosis in patients from UK CPRD database","volume":"15","author":"Kostikas","year":"2020","journal-title":"Int. J. Chronic Obstr. Pulm. Dis."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"707","DOI":"10.4103\/ijmr.IJMR_358_19","article-title":"Spirometry-based prevalence of chronic obstructive pulmonary disease & associated factors among community-dwelling rural elderly","volume":"154","author":"Kumar","year":"2021","journal-title":"Indian J. Med. Res."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"62","DOI":"10.1038\/s41533-017-0062-6","article-title":"Spirometry is not enough to diagnose COPD in epidemiological studies: A follow-up study","volume":"27","author":"Andreeva","year":"2017","journal-title":"npj Prim. Care Respir. Med."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.ejim.2019.12.014","article-title":"Understanding the impact of chronic obstructive pulmonary disease exacerbations on patient health and quality of life","volume":"73","author":"Hurst","year":"2020","journal-title":"Eur. J. Intern. Med."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"20","DOI":"10.2478\/pneum-2026-0004","article-title":"Towards a collaborative approach in chronic obstructive pulmonary disease: An expert opinion paper on cardiopulmonary risk reduction in clinical practice in Romania","volume":"75","author":"Isar","year":"2026","journal-title":"Pneumologia"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1080\/15412550801940721","article-title":"Development and Initial Validation of a Self-Scored COPD Population Screener Questionnaire (COPD-PS)","volume":"5","author":"Martinez","year":"2008","journal-title":"COPD"},{"key":"ref_14","first-page":"1","article-title":"Lung Function Questionnaire Working Group. Development of the Lung Function Questionnaire (LFQ) to identify airflow obstruction","volume":"18","author":"Yawn","year":"2010","journal-title":"Int. J. Chronic Obstr. Pulm. Dis."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1645","DOI":"10.5588\/ijtld.12.0995","article-title":"Development and validation of a chronic obstructive pulmonary disease screening questionnaire in China","volume":"17","author":"Zhou","year":"2013","journal-title":"Int. J. Tuberc. Lung Dis."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1901","DOI":"10.2147\/COPD.S152226","article-title":"Can CAPTURE be used to identify undiagnosed patients with mild-to-moderate COPD likely to benefit from treatment?","volume":"13","author":"Leidy","year":"2018","journal-title":"Int. J. Chronic Obstr. Pulm. Dis."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Mari, P.-V., Coppola, A., Ielo, S., Scala, R., de Corso, E., Ojetti, V., Ricci, A., Baglioni, S., and Carriera, L. (2026). How many blood eosinophil measurements are needed to identify COPD patients eligible for biologic therapy? A multi-source decision analysis simulation. Eur. J. Intern. Med., 107012.","DOI":"10.1016\/j.ejim.2026.107012"}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/62\/9\/1820\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T09:20:51Z","timestamp":1790155251000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/62\/9\/1820"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,21]]},"references-count":17,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2026,9]]}},"alternative-id":["medicina62091820"],"URL":"https:\/\/doi.org\/10.3390\/medicina62091820","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,21]]}}}