title: Validation of the COPD Diagnostic Questionnaire in an Australian general practice cohort: a cross-sectional study.
abstract: BACKGROUND
  The gold standard for the diagnosis of chronic obstructive pulmonary disease (COPD) is spirometry, but there are barriers to its use in primary care.
  
  
  OBJECTIVE
  To externally validate the COPD Diagnostic Questionnaire (CDQ) as a diagnostic tool in patients at increased risk in Australian general practice and to compare its performance with other CDQ validation studies.
  
  
  METHODS
  Patients were recruited from 36 general practices in Sydney, Australia. Former or current smokers aged 40-85 years with no prior COPD diagnosis were invited to a case-finding appointment with the practice nurse. The CDQ was collected and pre- and postbronchodilator spirometry was performed. Cases for whom complete CDQ data were present and the spirometry met quality standards were analysed.
  
  
  RESULTS
  Of 1,631 patients who attended case-finding recruitment, 1,054 (65%) could be analysed. Spirometry showed 13% had COPD. The ability of the CDQ to discriminate between patients with and without COPD was fair, represented by the area under the receiver operating characteristic curve of 0.713. With a CDQ cut-off point value of 16.5 the sensitivity was 80% and specificity 47% and, at a cut-off point value of 19.5, the sensitivity was 63% and specificity 70%.
  
  
  CONCLUSIONS
  The CDQ did not discriminate between patients with and without COPD accurately enough to use as a diagnostic tool in patients at increased risk of COPD in Australian general practice. Further research is needed on the value of the CDQ as a tool for selecting patients for spirometry.
authors.affiliation: School of Public Health and Community Medicine, University of New South Wales, Kensington, NSW, Australia.
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: Stanley
authors.forename: Iqbal
authors.initials: I
authors.lastname: Hasan
authors.forename: Alan J
authors.initials: AJ
authors.lastname: Crockett
authors.forename: Onno C P
authors.initials: OC
authors.lastname: van Schayck
authors.forename: Nicholas A
authors.initials: NA
authors.lastname: Zwar
mesh_terms: D000328:Adult; D000368:Aged; D001315:Australia; D003430:Cross-Sectional Studies; D005260:Female; D058006:General Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis*; D013147:Spirometry; D011795:Surveys and Questionnaires