title: Identifying cases of undiagnosed, clinically significant COPD in primary care: qualitative insight from patients in the target population.
abstract: BACKGROUND
  Many cases of chronic obstructive pulmonary disease (COPD) are diagnosed only after significant loss of lung function or during exacerbations.
  
  
  OBJECTIVE
  This study is part of a multi-method approach to develop a new screening instrument for identifying undiagnosed, clinically significant COPD in primary care.
  
  
  METHODS
  Subjects with varied histories of COPD diagnosis, risk factors and history of exacerbations were recruited through five US clinics (four pulmonary, one primary care). Phase I: Eight focus groups and six telephone interviews were conducted to elicit descriptions of risk factors for COPD, recent or historical acute respiratory events, and symptoms to inform the development of candidate items for the new questionnaire. Phase II: A new cohort of subjects participated in cognitive interviews to assess and modify candidate items. Two peak expiratory flow (PEF) devices (electronic, manual) were assessed for use in screening.
  
  
  RESULTS
  Of 77 subjects, 50 participated in Phase I and 27 in Phase II. Six themes informed item development: exposure (smoking, second-hand smoke); health history (family history of lung problems, recurrent chest infections); recent history of respiratory events (clinic visits, hospitalisations); symptoms (respiratory, non-respiratory); impact (activity limitations); and attribution (age, obesity). PEF devices were rated easy to use; electronic values were significantly higher than manual (P<0.0001). Revisions were made to the draft items on the basis of cognitive interviews.
  
  
  CONCLUSIONS
  Forty-eight candidate items are ready for quantitative testing to select the best, smallest set of questions that, together with PEF, can efficiently identify patients in need of diagnostic evaluation for clinically significant COPD.
authors.affiliation: Evidera, Bethesda, MD, USA.
authors.forename: Nancy K
authors.initials: NK
authors.lastname: Leidy
authors.affiliation: Evidera, Bethesda, MD, USA.
authors.forename: Katherine
authors.initials: K
authors.lastname: Kim
authors.affiliation: Evidera, Bethesda, MD, USA.
authors.forename: Elizabeth D
authors.initials: ED
authors.lastname: Bacci
authors.affiliation: Olmsted Medical Center, Rochester, MN, USA.
authors.forename: Barbara P
authors.initials: BP
authors.lastname: Yawn
authors.affiliation: University of Kentucky, Lexington, KY, USA.
authors.forename: David M
authors.initials: DM
authors.lastname: Mannino
authors.affiliation: Columbia University, New York, NY, USA.
authors.forename: Byron M
authors.initials: BM
authors.lastname: Thomashow
authors.affiliation: Columbia University, New York, NY, USA.
authors.forename: R Graham
authors.initials: RG
authors.lastname: Barr
authors.affiliation: University of Nebraska, Omaha, NE, USA.
authors.forename: Stephen I
authors.initials: SI
authors.lastname: Rennard
authors.affiliation: University of Nebraska, Omaha, NE, USA.
authors.forename: Julia F
authors.initials: JF
authors.lastname: Houfek
authors.affiliation: University of Michigan, Ann Arbor, MI, USA.
authors.forename: Meilan K
authors.initials: MK
authors.lastname: Han
authors.affiliation: University of Michigan, Ann Arbor, MI, USA.
authors.forename: Catherine A
authors.initials: CA
authors.lastname: Meldrum
authors.affiliation: National Jewish Health, Denver, CO, USA.
authors.forename: Barry J
authors.initials: BJ
authors.lastname: Make
authors.affiliation: National Jewish Health, Denver, CO, USA.
authors.forename: Russ P
authors.initials: RP
authors.lastname: Bowler
authors.affiliation: Evidera, Bethesda, MD, USA.
authors.forename: Anna W
authors.initials: AW
authors.lastname: Steenrod
authors.affiliation: Evidera, Bethesda, MD, USA.
authors.forename: Lindsey T
authors.initials: LT
authors.lastname: Murray
authors.affiliation: COPD Foundation, Washington, DC, USA.
authors.forename: John W
authors.initials: JW
authors.lastname: Walsh
authors.affiliation: Weill Cornell Medical Center, New York, NY, USA.
authors.forename: Fernando
authors.initials: F
authors.lastname: Martinez
mesh_terms: D000368:Aged; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D010366:Peak Expiratory Flow Rate; D011320:Primary Health Care; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology; D036301:Qualitative Research; D012307:Risk Factors; D012907:Smoking / Q000453:epidemiology; D013147:Spirometry