title: Diagnostic accuracy of screening tests for COPD: a systematic review and meta-analysis.
abstract: BACKGROUND
  Chronic obstructive pulmonary disease (COPD) is widely underdiagnosed. A number of studies have evaluated the accuracy of screening tests for COPD, but their findings have not been formally summarised. We therefore sought to determine and compare the diagnostic accuracy of such screening tests in primary care.
  
  
  METHODS
  Systematic review and meta-analysis of the diagnostic accuracy of screening tests for COPD confirmed by spirometry in primary care. We searched MEDLINE, EMBASE and other bibliographic databases from 1997 to 2013 for diagnostic accuracy studies that evaluated 1 or more index tests in primary care among individuals aged ≥35 years with no prior diagnosis of COPD. Bivariate meta-analysis of sensitivity and specificity was performed where appropriate. Methodological quality was assessed independently by 2 reviewers using the QUADAS-2 tool.
  
  
  RESULTS
  10 studies were included. 8 assessed screening questionnaires (the COPD Diagnostic Questionnaire (CDQ) was the most evaluated, n=4), 4 assessed handheld flow meters (eg, COPD-6) and 1 assessed their combination. Among ever smokers, the CDQ (score threshold ≥19.5; n=4) had a pooled sensitivity of 64.5% (95% CI 59.9% to 68.8%) and specificity of 65.2% (52.9% to 75.8%), and handheld flow meters (n=3) had a sensitivity of 79.9% (95% CI 74.2% to 84.7%) and specificity of 84.4% (68.9% to 93.0%). Inadequate blinding between index tests and spirometry was the main risk of bias.
  
  
  CONCLUSIONS
  Handheld flow meters demonstrated higher test accuracy than the CDQ for COPD screening in primary care. The choice of alternative screening tests within whole screening programmes should now be fully evaluated.
  CRD42012002074.
authors.affiliation: Public Health, Epidemiology & Biostatistics, School of Health and Population Sciences, University of Birmingham, Birmingham, UK.
authors.forename: Shamil
authors.initials: S
authors.lastname: Haroon
authors.affiliation: Public Health, Epidemiology & Biostatistics, School of Health and Population Sciences, University of Birmingham, Birmingham, UK.
authors.forename: Rachel
authors.initials: R
authors.lastname: Jordan
authors.affiliation: Public Health, Epidemiology & Biostatistics, School of Health and Population Sciences, University of Birmingham, Birmingham, UK.
authors.forename: Yemisi
authors.initials: Y
authors.lastname: Takwoingi
authors.affiliation: Public Health, Epidemiology & Biostatistics, School of Health and Population Sciences, University of Birmingham, Birmingham, UK.
authors.forename: Peymane
authors.initials: P
authors.lastname: Adab
mesh_terms: D003948:Diagnostic Techniques, Respiratory System / Q000592:standards*; D006801:Humans; D008403:Mass Screening / Q000379:methods*; D011320:Primary Health Care / Q000379:methods*; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis*; D015203:Reproducibility of Results; D011795:Surveys and Questionnaires
keywords: EPIDEMIOLOGY; PREVENTIVE MEDICINE; PRIMARY CARE; PUBLIC HEALTH