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Chest. 2012 Aug;142(2):358-366. doi: 10.1378/chest.11-1474.

Questionnaires and pocket spirometers provide an alternative approach for COPD screening in the general population.

Author information

1
American Association for Respiratory Care, Irving, TX. Electronic address: nelson@aarc.org.
2
University of North Carolina, Chapel Hill, NC.
3
COPD Foundation, Miami, FL.
4
University of Arizona, Tucson, AZ.
5
University of Michigan, Ann Arbor, MI.
6
University of Kentucky, Lexington, KY.
7
Columbia University, New York, NY.

Abstract

BACKGROUND:

In response to the Agency for Healthcare Research and Quality statement questioning the usefulness of “screening spirometry,” the National Heart, Lung, and Blood Institute and the COPD Foundation held a consensus conference in June 2008 to establish a procedure to detect cases of COPD in the general population. Conference participants developed a three-stage approach, using a brief questionnaire, peak flow measurement with a pocket spirometer, and diagnostic quality spirometry. The overall objective of this study was to examine the usefulness of a simple questionnaire and peak flow measurement in screening for COPD in a self-selected population. We hypothesized that this combination would efficiently screen for clinically relevant COPD.

METHODS:

We queried individuals attending public events regarding the presence of wheeze and/or asthma, mucus production, dyspnea, exposure to irritants, and tobacco use. Peak expiratory flow (PEF) was then measured with a pocket spirometer. If PEF was < 70% predicted, spirometry was performed. In order to estimate the false-negative rate, a random sample of every 10th participant was also selected for spirometry.

RESULTS:

Between June 2008 and December 2009, 5,761 adults completed the risk assessment questionnaire. The mean age of the respondents was 54 years, 58% were women, and 88% were white. Of these, 5,638 participants completed pocket spirometry, and 315 (5.6%) had PEF < 70% predicted. Of 5,323 with normal PEF, 651 underwent spirometry. The performance of PEF was assessed via positive and negative predictive values relative to a diagnosis of clinically significant airflow obstruction, defined as FEV(1)/FEV(6) < the lower limit of normal and FEV(1) < 60% predicted. Of 4,238 subjects with at least two risk factors, 267 (6.3%) had PEF < 70%, compared with 48 of the 1,400 subjects (3.4%) with fewer than two risk factors (P < .001). Based on 729 participants with acceptable spirometry, 63.1% (113 of 179) of those with abnormal PEF tested positive for clinically significant airflow obstruction, compared with 5.5% (30 of 550) with normal PEF (P < .001). The estimated prevalence of significant COPD among the 5,638 screened was 8.7%, and sensitivity and specificity were 40.7% and 97.7%, respectively.

CONCLUSIONS:

A staged approach to COPD screening in adults is useful for detecting clinically significant airflow obstruction in our study population.

PMID:
22194590
DOI:
10.1378/chest.11-1474
[Indexed for MEDLINE]

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