title: Case-finding options for COPD: results from the Burden of Obstructive Lung Disease study.
abstract: This study aimed to compare strategies for chronic obstructive pulmonary disease (COPD) case finding using data from the Burden of Obstructive Lung Disease study. Population-based samples of adults aged ≥40 yrs (n = 9,390) from 14 countries completed a questionnaire and spirometry. We compared the screening efficiency of differently staged algorithms that used questionnaire data and/or peak expiratory flow (PEF) data to identify persons at risk for COPD and, hence, needing confirmatory spirometry. Separate algorithms were fitted for moderate/severe COPD and for severe COPD. We estimated the cost of each algorithm in 1,000 people. For moderate/severe COPD, use of questionnaire data alone permitted high sensitivity (97%) but required confirmatory spirometry in 80% of participants. Use of PEF necessitated confirmatory spirometry in only 19-22% of subjects, with 83-84% sensitivity. For severe COPD, use of PEF achieved 91-93% sensitivity, requiring confirmatory spirometry in <9% of participants. Cost analysis suggested that a staged screening algorithm using only PEF initially, followed by confirmatory spirometry as needed, was the most cost-effective case-finding strategy. Our results support the use of PEF as a simple, cost-effective initial screening tool for conducting COPD case-finding in adults aged ≥40 yrs. These findings should be validated in real-world settings such as the primary care environment.
authors: National Heart and Lung Institute, Imperial College London, London, UK.
authors: Anamika
authors: A
authors: Jithoo
authors: Paul L
authors: PL
authors: Enright
authors: Peter
authors: P
authors: Burney
authors: A Sonia
authors: AS
authors: Buist
authors: Eric D
authors: ED
authors: Bateman
authors: Wan C
authors: WC
authors: Tan
authors: Michael
authors: M
authors: Studnicka
authors: Filip
authors: F
authors: Mejza
authors: Suzanne
authors: S
authors: Gillespie
authors: William M
authors: WM
authors: Vollmer
mesh_terms: D000328:Adult; D000368:Aged; D000465:Algorithms; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D010366:Peak Expiratory Flow Rate; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis* / Q000503:physiopathology*; D015272:Pulmonary Medicine / Q000379:methods / Q000592:standards; D012129:Respiratory Function Tests / Q000191:economics*; D012680:Sensitivity and Specificity; D013147:Spirometry / Q000379:methods; D011795:Surveys and Questionnaires