title: Comparison of Three Screening Questionnaires for Chronic Obstructive Pulmonary Disease in the Primary Care.
abstract: BACKGROUND
  Even though the diagnosis of chronic obstructive pulmonary disease (COPD) is easy and based mainly on spirometry and symptoms, the prevalence of underdiagnosis is extremely high. The use of simple screening tools (e.g., questionnaires, hand-held spirometers) has been proved to be a simple method for case finding of COPD. Nevertheless the most appropriate target group of the general population has not been specified yet.
  
  
  OBJECTIVE
  The aim of the present study was to compare 3 screening questionnaires among smokers aged >40 years in the primary care setting.
  
  
  METHODS
  We excluded all subjects with a previous medical diagnosis of bronchial asthma or chronic pulmonary disease other than COPD. All participants were in a stable clinical condition, filled in the International Primary Care Airways Group (IPAG) questionnaire, the COPD Population Screener (COPD-PS) questionnaire, and the Lung Function Questionnaire (LFQ) and underwent spirometry. Medical diagnosis of COPD was established by an experienced pulmonologist.
  
  
  RESULTS
  We studied 3,234 subjects during a 3.5-year period. COPD prevalence was 10.9% (52.1% underdiagnosis). All 3 questionnaires showed extremely high negative predictive values (94-96%), so in this case the diagnosis of COPD could be safely excluded. The area under the curve was similar across the 3 questionnaires (AUCROC: 0.794-0.809). The COPD-PS questionnaire demonstrated the highest positive predictive value (41%) compared to the other 2. On the other hand, the IPAG questionnaire and LFQ demonstrated higher sensitivities than COPD-PS resulting in lower percentages of missed cases.
  
  
  CONCLUSIONS
  Three validated screening questionnaires for COPD demonstrated different diagnostic characteristics.
authors.affiliation: Pulmonary Department, Aristotle University of Thessaloniki, "G. Papanikolaou" Hospital, Exohi, Greece.
authors.forename: Dionisios
authors.initials: D
authors.lastname: Spyratos
authors.forename: Anna-Bettina
authors.initials: AB
authors.lastname: Haidich
authors.forename: Diamantis
authors.initials: D
authors.lastname: Chloros
authors.forename: Dionisia
authors.initials: D
authors.lastname: Michalopoulou
authors.forename: Lazaros
authors.initials: L
authors.lastname: Sichletidis
mesh_terms: D000328:Adult; D000368:Aged; D019540:Area Under Curve; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D008297:Male; D008403:Mass Screening; D008450:Maximal Midexpiratory Flow Rate; D008875:Middle Aged; D011237:Predictive Value of Tests; D015995:Prevalence; D011320:Primary Health Care; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis* / Q000453:epidemiology; D015203:Reproducibility of Results; D012907:Smoking / Q000453:epidemiology*; D011795:Surveys and Questionnaires; D014797:Vital Capacity