title: Predischarge screening for chronic obstructive pulmonary disease in patients with acute coronary syndrome and smoking history.
abstract: BACKGROUND
  Several studies suggested that chronic obstructive pulmonary disease (COPD) is largely underdiagnosed in patients with acute coronary syndrome (ACS) contributing to further affect clinical outcome. Our aim was to validate a screening procedure to identify, in ACS patients, those with negligible risk of undiagnosed COPD.
  
  
  METHODS
  From December 2014 to August 2015, 169 ACS patients with smoking history underwent screening procedure. Screening procedure combined peak expiratory flow rate (PEFR, defined as positive if <80% of predicted) and respiratory health status questionnaire (RHSQ, defined as positive if >19.5 points). The screening was considered negative if both tests provided negative results, positive if both were positive, uncertain in presence of discrepancy. Spirometry was planned after 2months to identify or not the presence of irreversible airflow obstruction (undiagnosed COPD). The primary endpoint was the negative predictive value of screening for undiagnosed COPD.
  
  
  RESULTS
  Overall, 137 (81%) patients received spirometry (final study population). Screening was negative, uncertain and positive in 58 (42%), 46 (34%) and 33 (24%) patients, respectively. We found undiagnosed COPD in 39 (29%) patients. Only 3 patients with negative screening showed undiagnosed COPD. Negative screening showed the best ability to discriminate patients without COPD (negative predictive value 95%). Two-month health status in patients with undiagnosed COPD was significantly poor.
  
  
  CONCLUSIONS
  Undiagnosed COPD is relatively frequent in ACS patients with smoking history and a simple screening procedure including PEFR and RHSQ can be administered before hospital discharge to discriminate those at negligible risk of undiagnosed COPD (ClinicalTrials.gov, NCT02324660).
authors: Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, Cona, (FE), Italy; Laboratorio per le Tecnologie delle Terapie Avanzate (LTTA) Center, Ferrara, Italy. Electronic address: cmpglc@unife.it.
authors: Gianluca
authors: G
authors: Campo
authors: Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, Cona, (FE), Italy.
authors: Rita
authors: R
authors: Pavasini
authors: Research Centre on Asthma and COPD, Section of Internal and Cardio-Respiratory Medicine, University of Ferrara, Ferrara, Italy.
authors: Carlo
authors: C
authors: Barbetta
authors: Center for Clinical and Epidemiological Research, Azienda Ospedaliero-Universitaria di Ferrara, Cona, (FE), Italy.
authors: Elisa
authors: E
authors: Maietti
authors: Research Centre on Asthma and COPD, Section of Internal and Cardio-Respiratory Medicine, University of Ferrara, Ferrara, Italy.
authors: Susanna
authors: S
authors: Mascetti
authors: Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, Cona, (FE), Italy.
authors: Simone
authors: S
authors: Biscaglia
authors: Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, Cona, (FE), Italy.
authors: Fatima
authors: F
authors: Zaraket
authors: Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, Cona, (FE), Italy.
authors: Giosafat
authors: G
authors: Spitaleri
authors: Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, Cona, (FE), Italy.
authors: Francesco
authors: F
authors: Gallo
authors: Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, Cona, (FE), Italy.
authors: Elisabetta
authors: E
authors: Tonet
authors: Research Centre on Asthma and COPD, Section of Internal and Cardio-Respiratory Medicine, University of Ferrara, Ferrara, Italy.
authors: Alberto
authors: A
authors: Papi
authors: Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, Cona, (FE), Italy; Laboratorio per le Tecnologie delle Terapie Avanzate (LTTA) Center, Ferrara, Italy; Maria Cecilia Hospital, GVM Care & Research, E.S.: Health Science Foundation, Cotignola, Italy.
authors: Roberto
authors: R
authors: Ferrari
authors: Research Centre on Asthma and COPD, Section of Internal and Cardio-Respiratory Medicine, University of Ferrara, Ferrara, Italy.
authors: Marco
authors: M
authors: Contoli
mesh_terms: D054058:Acute Coronary Syndrome / Q000150:complications*; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D005541:Forced Expiratory Volume; D006801:Humans; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D008168:Lung / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge; D011237:Predictive Value of Tests; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D012307:Risk Factors; D012720:Severity of Illness Index; D012907:Smoking / Q000009:adverse effects*; D013147:Spirometry; D011795:Surveys and Questionnaires
keywords: Acute coronary syndrome; Chronic obstructive pulmonary disease; Peak expiratory flow rate; Respiratory health screening questionnaire; Screening