A comparison of five surveys that identify individuals at risk for airflow obstruction and chronic obstructive pulmonary disease.
The predictive characteristics of different screening surveys for the recognition of individuals at risk for airflow obstruction (AFO) have not been evaluated simultaneously in the same population.



To compare five AFO/COPD screening questionnaires.



383 individuals completed the Veterans Airflow Obstruction Screening Questionnaire, Personal Level Screener for COPD (VAFOSQ), the 11-Q COPD Screening Questionnaire (11-Q), the COPD Population Screener (COPD-PS) and the Lung Function Questionnaire (LFQ) and performed spirometry. AFO was defined as forced expiratory volume in one second divided by the forced vital capacity (FEV1/FVC) < 0.7, fixed ratio (FR) or FEV1/FVC < lower limit of normal (LLN). The predictive characteristics of the five questionnaires were calculated and non-parametric receiver operating characteristic (ROC) curves estimated by logistic regression.



376 participants completed at least two of the questionnaires and performed technically acceptable spirometry. AFO was present in 102 (27.1%) and 150 (39.9%) based on LLN and FR, respectively. The number of individuals positively selected by the VAFOSQ was 227, PLS 128, 11-Q 236, COPD-PS 217, and LFQ 328. The area under the ROC curves for the questionnaires was between 0.60 and 0.66 (LLN) and 0.58 and 0.66 (FR).



Although these screening surveys have acceptable and similar predictive ability for the identification of AFO, their published thresholds lead to substantially different classification rates. The choice of an appropriate threshold for the identification of individuals with possible AFO/COPD should consider the underlying prevalence of AFO/COPD in the target population and the relative costs of misclassifying affected and unaffected cases.



None.



Veterans Health Administration.
Division of Pulmonary, Critical Care, and Sleep Medicine, Cincinnati Veterans Affairs Medical Center, United States.
Folarin
F
Sogbetun
Division of Pulmonary, Critical Care, and Sleep Medicine, Cincinnati Veterans Affairs Medical Center, United States; Division of Pulmonary, Critical Care, and Sleep Medicine, University of Cincinnati College of Medicine, United States.
William L
WL
Eschenbacher
Department of Psychiatry & Behavioral Neuroscience, Department of Environmental Health (Division of Biostatistics and Bioinformatics), University of Cincinnati College of Medicine, United States.
Jeffrey A
JA
Welge
Division of Pulmonary, Critical Care, and Sleep Medicine, Cincinnati Veterans Affairs Medical Center, United States; Division of Pulmonary, Critical Care, and Sleep Medicine, University of Cincinnati College of Medicine, United States. Electronic address: ralph.panos@va.gov.
Ralph J
RJ
Panos
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods; D008875:Middle Aged; D011237:Predictive Value of Tests; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology*; D012129:Respiratory Function Tests / Q000379:methods; D012307:Risk Factors; D013147:Spirometry / Q000379:methods; D011795:Surveys and Questionnaires; D014728:Veterans; D058014:Veterans Health; D014797:Vital Capacity
Chronic obstructive pulmonary disease; Questionnaire; Screening