title: Development and initial validation of a self-scored COPD Population Screener Questionnaire (COPD-PS).
abstract: COPD has a profound impact on daily life, yet remains underdiagnosed and undertreated. We set out to develop a brief, reliable, self-scored questionnaire to identify individuals likely to have COPD. COPD-PS development began with a list of concepts identified for inclusion using expert opinion from a clinician working group comprised of pulmonologists (n = 5) and primary care clinicians (n = 5). A national survey of 697 patients was conducted at 12 practitioner sites. Logistic regression identified items discriminating between patients with and without fixed airflow obstruction (AO, postbronchodilator FEV(1)/FVC < 70%). ROC analyses evaluated screening accuracy, compared scoring options, and assessed concurrent validity. Convergent and discriminant validity were assessed via COPD-PS and SF-12v2 score correlations. For known-groups validation, COPD-PS differences between clinical groups were tested. Test-retest reliability was evaluated in a 20% sample. Of 697 patients surveyed, 295 patients met expert review criteria for spirometry performance; 38% of these (n = 113) had results indicating AO. Five items positively predicted AO (p < 0.0001): breathlessness, productive cough, activity limitation, smoking history, and age. COPD-PS scores accurately classified AO status (area under ROC curve = 0.81) and reliable (r = 0.91). Patients with spirometry indicative of AO scored significantly higher (6.8, SD = 1.9; p< 0.0001) than patients without AO (4.0, SD = 2.3). Higher scores were associated with more severe AO, bronchodilator use, and overnight hospitalization for breathing problems. With the prevalence of COPD in the studied cohort, a score on the COPD-PS of greater than five was associated with a positive predictive value of 56.8% and negative predictive value of 86.4%. The COPD-PS accurately classified physician-reported COPD (AUC = 0.89). The COPD-PS is a brief, accurate questionnaire that can identify individuals likely to have COPD.
authors.affiliation: Division of Pulmonary and Critical Care Medicine, University of Michigan Health System, Ann Arbor, MI 48109, USA. fmartine@umich.edu
authors.forename: Fernando J
authors.initials: FJ
authors.lastname: Martinez
authors.forename: Anastasia E
authors.initials: AE
authors.lastname: Raczek
authors.forename: Frederic D
authors.initials: FD
authors.lastname: Seifer
authors.forename: Craig S
authors.initials: CS
authors.lastname: Conoscenti
authors.forename: Tammy G
authors.initials: TG
authors.lastname: Curtice
authors.forename: Thomas
authors.initials: T
authors.lastname: D'Eletto
authors.forename: Claudia
authors.initials: C
authors.lastname: Cote
authors.forename: Clare
authors.initials: C
authors.lastname: Hawkins
authors.forename: Amy L
authors.initials: AL
authors.lastname: Phillips
mesh_terms: D000328:Adult; D000368:Aged; D006801:Humans; D008875:Middle Aged; D011237:Predictive Value of Tests; D029424:Pulmonary Disease, Chronic Obstructive / Q000503:physiopathology*; D012123:Pulmonary Ventilation; D012372:ROC Curve; D012647:Self-Assessment; D012680:Sensitivity and Specificity; D013147:Spirometry; D011795:Surveys and Questionnaires