Performance and Clinical Utility of Various Chronic Obstructive Pulmonary Disease Case-Finding Tools
Year: 2021
Type: article
Study design: Observational Study
Abstract: Background and Aim: Chronic obstructive pulmonary disease (COPD) is frequently underdiagnosed because of the unavailability of spirometers, especially in resource-limited outpatient settings. This study provides real-world evidence to identify optimal approaches for COPD case finding in outpatient settings. Methods: This retrospective study enrolled individuals who were at risk of COPD (age ≥ 40 years, ≥ 10 pack-years, and ≥ 1 respiratory symptom). Eligible participants were examined using various COPD case-finding tools, namely the COPD Population Screener (COPD-PS) questionnaire, a COPD prediction (P COPD ) model, and a microspirometer, Spirobank Smart; subsequently, the participants underwent confirmatory spirometry. The definition and confirmation of COPD were based on conventional spirometry. Receiver operating characteristic curve (ROC), area under the curve (AUC), and decision curve analyses were conducted, and a clinical impact curve was constructed. Results: In total, 385 participants took part in the study [284 without COPD (73.77%) and 101 with COPD (26.23%)]. The microspirometer exhibited a higher AUC value than did the COPD-PS questionnaire and the P COPD model. The AUC for microspirometry was 0.908 (95% confidence interval [CI] = 0.87– 0.95), that for the P COPD model was 0.788 (95% CI = 0.74– 0.84), and that for the COPD-PS questionnaire was 0.726 (95% CI = 0.67– 0.78). Decision and clinical impact curve analyses revealed that a microspirometry-derived FEV1/FVC ratio of < 74% had superior clinical utility to the other measurement tools. Conclusion: The P COPD model and COPD-PS questionnaire were useful for identifying symptomatic patients likely to have COPD, but microspirometry was more accurate and had higher clinical utility. This study provides real-world evidence to identify optimal practices for COPD case finding; such practices ensure that physicians have convenient access to up-to-date evidence when they encounter a symptomatic patient likely to have COPD. Keywords: COPD, COPD case-finding, P COPD model, COPD-PS questionnaire, microspirometry, spirometry
Source: International Journal of COPD
DOI: 10.2147/copd.s339340
Institutions: National Cheng Kung University Hospital, National Cheng Kung University, Kaohsiung Medical University Chung-Ho Memorial Hospital, Far Eastern Memorial Hospital, Yuan Ze University, National Taiwan University Hospital, Chia-Yi Christian Hospital, China Medical University Hospital, Chang Gung University, Kaohsiung Chang Gung Memorial Hospital, Taipei Medical University-Shuang Ho Hospital, Taipei Medical University, Taipei Veterans General Hospital, Fu Jen Catholic University, Cardinal Tien Hospital, Changhua Christian Hospital, Kaohsiung Medical University, Chang Gung Memorial Hospital, Taoyuan Chang Gung Memorial Hospital, Linkou Chang Gung Memorial Hospital, Mackay Memorial Hospital, MingDao University, National Chung Hsing University
Language: English
Subfield: Pulmonary and Respiratory Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $2,836
Funder: Changhua Christian Hospital
Award: G4953269565
OpenAlex ID: W4200425117