Symptom-based questionnaire for identifying COPD in smokers.
BACKGROUND
Symptom-based questionnaires may enhance chronic obstructive pulmonary disease (COPD) screening in primary care.


OBJECTIVE
We prospectively tested questions to help identify COPD among smokers without prior history of lung disease.


METHODS
Subjects were recruited via random mailing to primary care practices in Aberdeen, UK, and Denver, Colo., USA. Current and former smokers aged 40 or older with no prior respiratory diagnosis and no respiratory medications in the past year were enrolled. Participants answered questions covering demographics and symptoms and then underwent spirometry with reversibility testing. A study diagnosis of COPD was defined as fixed airway obstruction as measured by post-bronchodilator FEV(1)/FVC <0.70. We examined the ability of individual questions in a multivariate framework to correctly discriminate between persons with and without COPD.


RESULTS
818 subjects completed all investigations and proceeded to analysis. The list of 54 questions yielded 52 items for analysis, which was reduced to 17 items for entry into multivariate regression. Eight items had significant relationships with the study diagnosis of COPD, including age, pack-years, body mass index, weather-affected cough, phlegm without a cold, morning phlegm, wheeze frequency, and history of any allergies. Individual items yielded odds ratios ranging from 0.23 to 12. This questionnaire demonstrated a sensitivity of 80.4 and specificity of 72.0.


CONCLUSIONS
A simple patient self-administered questionnaire can be used to identify patients with a high likelihood of having COPD, for whom spirometric testing is particularly important. Implementation of this questionnaire could enhance the efficiency and diagnostic accuracy of current screening efforts.
Price
David B
DB
University of Aberdeen, Aberdeen, UK.
Tinkelman
David G
DG
Halbert
R J
RJ
Nordyke
Robert J
RJ
Isonaka
Sharon
S
Nonikov
Dmitry
D
Juniper
Elizabeth F
EF
Freeman
Daryl
D
Hausen
Thomas
T
Levy
Mark L
ML
Ostrem
Anders
A
van der Molen
Thys
T
van Schayck
Constant P
CP
D000328:Adult; D003120:Colorado / Q000453:epidemiology; D003937:Diagnosis, Differential; D005260:Female; D005541:Forced Expiratory Volume / Q000502:physiology; D006801:Humans; D015994:Incidence; D008297:Male; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D015203:Reproducibility of Results; D012907:Smoking / Q000009:adverse effects* / Q000453:epidemiology / Q000503:physiopathology; D013147:Spirometry; D011795:Surveys and Questionnaires; D006113:United Kingdom / Q000453:epidemiology