title: Which is the Best Screening Strategy for COPD among Smokers in Primary Care?
abstract: We developed a questionnaire to detect cases of chronic obstructive pulmonary disease (COPD) and compared its reliability with other strategies. In order to develop the new questionnaire (COPD screening questionnaire from Terrassa [EGARPOC]) we used data from an epidemiological study on the prevalence of COPD in smokers and calculated the odds ratio for each variable showing significance for the diagnosis of COPD on regression analysis. For comparison among questionnaires and the portable spirometer COPD-6, a cross-sectional multicenter study was performed. The study included 407 smokers or ex-smokers over the age of 40 years with no known diagnosis of COPD, who completed the different questionnaires (EGARPOC, Respiratory Health Screening Questionnaire, COPD-population screener and 2 questions) and underwent spirometry with the COPD-6. We determined the sensitivity, specificity, positive and negative predictive values (S, Sp, PPV and NPV, respectively) and the area under the receiver operating characteristic ROC curve (AUC ROC) of all the questionnaires and the different COPD-6 cut-offs. The prevalence of COPD was 26.3%. The EGARPOC questionnaire showed an S of 81.8%, an Sp of 70.6%, and an NPV of 91.8%; 73.3% of individuals were correctly classified, and the AUC ROC was 0.841. On comparing the questionnaires by the Chi-square test, the 2-question questionnaire showed the worst discrimination; while with an optimal cut-off of forced expiratory volume in one 1 second (FEV1)/FEV6of 0.78, the COPD-6 was significantly better than the questionnaires in the detection of COPD. Using a cut-off of FEV1/FEV6of 0.78 the COPD-6 was found to be the best screening tool for COPD in primary care compared to the questionnaires tested, which did not show differences among them.
authors: a CAP Terrassa Sud. Hospital Universitario Mutua de Terrassa, Universidad de Barcelona , Barcelona , Spain.
authors: Montserrat
authors: M
authors: Llordés
authors: a CAP Terrassa Sud. Hospital Universitario Mutua de Terrassa, Universidad de Barcelona , Barcelona , Spain.
authors: Elba
authors: E
authors: Zurdo
authors: b Coordinació projectes recerca, Fundació Docència i Recerca Mutua de Terrassa , Terrassa , Spain.
authors: Ángeles
authors: Á
authors: Jaén
authors: a CAP Terrassa Sud. Hospital Universitario Mutua de Terrassa, Universidad de Barcelona , Barcelona , Spain.
authors: Inmaculada
authors: I
authors: Vázquez
authors: c CAP Terrassa Oest. Hospital Universitario Mutua de Terrassa, Universidad de Barcelona , Barcelona , Spain.
authors: Luís
authors: L
authors: Pastrana
authors: d Pneumology Department , Hospital Universitari Vall d'Hebron, CIBER de Enfermedades Respiratorias (CIBERES) , Barcelona , Spain.
authors: Marc
authors: M
authors: Miravitlles
mesh_terms: D000368:Aged; D019540:Area Under Curve; D003430:Cross-Sectional Studies; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D011237:Predictive Value of Tests; D011320:Primary Health Care / Q000379:methods*; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis* / Q000503:physiopathology; D012372:ROC Curve; D015203:Reproducibility of Results; D012907:Smoking; D013147:Spirometry / Q000295:instrumentation; D011795:Surveys and Questionnaires
keywords: COPD; portable spirometry; prevalence; primary care; questionnaires; screening