title: Assessment of five different guideline indication criteria for spirometry, including modified GOLD criteria, in order to detect COPD: data from 5,315 subjects in the PLATINO study.
abstract: BACKGROUND
  Spirometry is the gold standard for diagnosing chronic obstructive pulmonary disease (COPD). Although there are a number of different guideline criteria for deciding who should be selected for spirometric screening, to date it is not known which criteria are the best based on sensitivity and specificity.
  
  
  OBJECTIVE
  Firstly, to evaluate the proportion of subjects in the PLATINO Study that would be recommended for spirometry testing according to Global initiative for Obstructive Lung Disease (GOLD)-modified, American College of Chest Physicians (ACCP), National Lung Health Education Program (NLHEP), GOLD and American Thoracic Society/European Respiratory Society (ATS/ERS) criteria. Secondly, we aimed to compare the sensitivity, specificity, and positive predictive and negative predictive values, of these five different criteria.
  
  
  METHODS
  Data from the PLATINO study included information on respiratory symptoms, smoking and previous spirometry testing. The GOLD-modified spirometry indication criteria are based on three positive answers out of five questions: the presence of cough, phlegm in the morning, dyspnoea, age over 40 years and smoking status.
  
  
  RESULTS
  Data from 5,315 subjects were reviewed. Fewer people had an indication for spirometry (41.3%) according to the GOLD-modified criteria, and more people had an indication for spirometry (80.4%) by the GOLD and ATS/ERS criteria. A low percentage had previously had spirometry performed: GOLD-modified (14.5%); ACCP (13.2%); NLHEP (12.6%); and GOLD and ATS/ERS (12.3%). The GOLD-modified criteria showed the least sensitivity (54.9) and the highest specificity (61.0) for detecting COPD, whereas GOLD and ATS/ERS criteria showed the highest sensitivity (87.9) and the least specificity (20.8).
  
  
  CONCLUSIONS
  There is a considerable difference in the indication for spirometry according to the five different guideline criteria. The GOLD-modified criteria recruit less people with the greatest sum of sensitivity and specificity.
authors.affiliation: Respiratory Division, Universidade Federal de São Paulo, São Paulo, Brazil.
authors.forename: Ana P
authors.initials: AP
authors.lastname: Luize
authors.affiliation: Epidemiology Division, Universidade Federal de Pelotas, Pelotas, Brazil.
authors.forename: Ana Maria B
authors.initials: AM
authors.lastname: Menezes
authors.affiliation: Respiratory Division, Instituto Nacional de Enfermedades Respiratorias, Mexico City, Mexico.
authors.forename: Rogelio
authors.initials: R
authors.lastname: Perez-Padilla
authors.affiliation: Respiratory Division, Universidad de la República, Montevideo, Uruguay.
authors.forename: Adriana
authors.initials: A
authors.lastname: Muiño
authors.affiliation: Respiratory Division, Universidad de la República, Montevideo, Uruguay.
authors.forename: Maria Victorina
authors.initials: MV
authors.lastname: López
authors.affiliation: Respiratory Division, Pontifícia Universidad Católica de Chile, Santiago, Chile.
authors.forename: Gonzalo
authors.initials: G
authors.lastname: Valdivia
authors.affiliation: Respiratory Division, Pontifícia Universidad Católica de Chile, Santiago, Chile.
authors.forename: Carmem
authors.initials: C
authors.lastname: Lisboa
authors.affiliation: Respiratory Division, Universidad Central de Venezuela, Caracas, Venezuela.
authors.forename: Maria
authors.initials: M
authors.lastname: Montes de Oca
authors.affiliation: Respiratory Division, Universidad Central de Venezuela, Caracas, Venezuela.
authors.forename: Carlos
authors.initials: C
authors.lastname: Tálamo
authors.affiliation: Brighans Women´s Hospital, Harvard University, Boston, MA, USA.
authors.forename: Bartolomé
authors.initials: B
authors.lastname: Celli
authors.affiliation: Respiratory Division, Universidade Federal de São Paulo, São Paulo, Brazil.
authors.forename: Oliver A
authors.initials: OA
authors.lastname: Nascimento
authors.affiliation: Respiratory Division, Universidade Federal de São Paulo, São Paulo, Brazil.
authors.forename: Mariana R
authors.initials: MR
authors.lastname: Gazzotti
authors.affiliation: Respiratory Division, Universidade Federal de São Paulo, São Paulo, Brazil.
authors.forename: José R
authors.initials: JR
authors.lastname: Jardim
mesh_terms: D005260:Female; D006801:Humans; D007843:Latin America; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis*; D012680:Sensitivity and Specificity; D013147:Spirometry / Q000592:standards*