Accuracy of the COPD diagnostic questionnaire as a screening tool in primary care

Screening of COPD patients using the COPD diagnostic questionnaire and a portable spirometer in primary healthcare institutions: a cross-sectional, diagnostic study

BACKGROUND

Portable spirometers and chronic obstructive pulmonary disease (COPD) diagnostic questionnaires are commonly used for screening patients with COPD in primary healthcare institutions, but their accuracy is often inadequate. This study aimed to explore the accuracy of combining these two tools in screening for COPD.

METHODS

Participants aged ≥ 40 years were recruited from primary healthcare institutions between July 2022 and July 2023. All participants completed COPD diagnostic questionnaires (CDQs) and pulmonary function tests including pre and post bronchodilator maneuvers using a portable spirometer at primary healthcare institutions and a conventional spirometer at a tertiary hospital. COPD was diagnosed based on the forced expiratory volume/forced vital capacity (FEV1/FVC) ratio measured by the conventional spirometer after administration of 400 µg of salbutamol sulfate. An FEV1/FVC ratio of < 70% indicated COPD, while an FEV1/FVC ratio of ≥ 70% was classified as non-COPD. The sensitivity and specificity of combining the portable spirometer and CDQ for COPD screening were statistically analyzed. Receiver operating characteristic (ROC) curves were employed to compare the efficacy of the portable spirometer, CDQ, and their combination in diagnosing COPD.

RESULTS

Of the 2,120 participants, 264 were newly diagnosed with COPD. Among the non-COPD population, 264 participants were matched by age, sex, and BMI to form the non-COPD group. The sensitivity and specificity of the combination of the portable spirometer and CDQ in diagnosing COPD were 96.6% (95% confidence interval [CI]: 0.934-0.983) and 79.9% (95% CI: 0.745-0.845), respectively, significantly higher than those with the use of either method alone (p < 0.05). The area under the ROC curve for the combined diagnosis of COPD was 0.994 (95% CI: 0.983-0.999), with a Jordan index of 0.765.

CONCLUSIONS

Our findings suggest that combining the portable spirometer with the CDQ enhances COPD detection and is a valuable approach for implementation in primary healthcare institutions.

TRIAL REGISTRATION

This study has been registered in national medical research registration and filing information system of China, www.medicalresearch.org.cn , Trail registration number: MR-11-23-020214.

Proposing the potential of utilizing the CAT score for early detection of COPD in asymptomatic patients, shifting towards a patient-centered approach: A review

Chronic obstructive pulmonary disease (COPD) constitutes a significant public health challenge, with delayed diagnosis and underdiagnosis being pervasive issues. The United States Preventive Service Task Force recommends restricting COPD screening to symptomatic smokers, a focus that has exhibited limitations, leading to delayed diagnoses, and imposing a substantial burden on patients, their families, and the healthcare system. This paper explores an alternative approach, highlighting the potential utility of the COPD assessment test (CAT) score as a prescreening tool. A CAT score of 10 or higher could serve as an appropriate threshold for further diagnostic procedures, given its robust correlation with pulmonary function test parameters and is valuable capacity to quantify patients' symptoms. The utilization of CAT as a prescreening tool in primary care signifies a transition towards a more patient-centered and comprehensive approach to COPD diagnosis and care.

Estimating the global prevalence of chronic obstructive pulmonary disease (COPD): a systematic review and meta-analysis

BACKGROUND

Chronic obstructive pulmonary disease (COPD) is a major public health problem. The present study aims to provide a global and regional estimate of the prevalence of COPD based on spirometry according to the two most widely used diagnostic criteria of COPD: fixed ratio (FR) and lower limit of normal (LLN).

METHODS

We conducted a systematic review of the literature according to PRISMA guidelines. MEDLINE, Web of Sciences, and Scopus databases were searched to identify studies on the spirometry-based prevalence of COPD in individuals aged 40 years and older. The meta-analysis was performed using MedCalc 19 software.

RESULTS

In total, 42 of the 3393 studies reviewed were eligible for inclusion. The overall prevalence of COPD in people aged 40 years and older was 12.64% (95% CI 10.75%-14.65%) and 7.38% (95% CI 5.47% - 9.55%) based on FR and LLN criteria, respectively. By gender, men had a higher prevalence of COPD compared to women (15.47%; 95% CI 12.22%-19.02% for men versus 8.79%; 95% CI 6.94%-10.82% for women). Using the LLN criteria, the prevalence of COPD in both sexes was almost identical (8.67%; 95% CI 8.44%- 8.90% for men and 8.00%; 95% CI 6.42% - 9.73% for women). We reported a high prevalence of COPD among smokers and the elderly by both definitions of airway obstruction. Regional prevalence estimates using the FR definition indicate that the highest COPD prevalence was recorded in the Americas and the lowest was recorded in the Eastern Mediterranean region. Using the LLN definition, the highest prevalence was recorded in the Southeast Asian region and the lowest prevalence was recorded in the American region. The most common COPD stage was stage II, with a prevalence of 50.46%. The results indicate a huge lack of prevalence data in the African and Eastern Mediterranean region. The results were given using a random-effect model due to the high heterogeneity between studies.

CONCLUSION

Results show that the prevalence of COPD differs according to the diagnostic criteria used. In addition, management and prevention strategies targeting risk factors for COPD are certainly needed to reduce the global burden of this chronic respiratory disease.