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Su KC, Hsiao YH, Ko HK, Chou KT, Jeng TH, Perng DW. The Accuracy of PUMA Questionnaire in Combination With Peak Expiratory Flow Rate to Identify At-risk, Undiagnosed COPD Patients. Arch Bronconeumol 2024:S0300-2896(24)00234-5. [PMID: 38987113 DOI: 10.1016/j.arbres.2024.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 05/29/2024] [Accepted: 06/15/2024] [Indexed: 07/12/2024]
Abstract
INTRODUCTION The English PUMA questionnaire emerges as an effective COPD case-finding tool. We aimed to use the PUMA questionnaire in combination with peak expiratory flow rate (PEFR) to improve case-finding efficacy in Chinese population. METHODS This cross-sectional, observational study included two stages: translating English to Chinese PUMA (C-PUMA) questionnaire with linguistic validation and psychometric evaluation, followed by clinical validation. Eligible participants (with age ≥40 years, respiratory symptoms, smoking history ≥10 pack-years) were enrolled and subjected to three questionnaires (C-PUMA, COPD assessment test [CAT], and generic health survey [SF-12V2]), PEFR measurement, and confirmatory spirometry. The C-PUMA score and PEFR were incorporated into a PUMA-PEFR prediction model applying binary logistic regression coefficients to estimate the probability of COPD (PCOPD). RESULTS C-PUMA was finalized through standard forward-backward translation processes and confirmation of good readability, comprehensibility, and reliability. In clinical validation, 240 participants completed the study. 78/240 (32.5%) were diagnosed with COPD. C-PUMA exhibited significant validity (correlated with CAT or physical component scores of SF-12V2, both P<0.05, respectively). PUMA-PEFR model had higher diagnostic accuracy than C-PUMA alone (area under ROC curve, 0.893 vs. 0.749, P<0.05). The best cutoff values of C-PUMA and PUMA-PEFR model (PCOPD) were ≥6 and ≥0.39, accounting for a sensitivity/specificity/numbers needed to screen of 77%/64%/3 and 79%/88%/2, respectively. C-PUMA ≥5 detected more underdiagnosed patients, up to 11.5% (vs. C-PUMA ≥6). CONCLUSION C-PUMA is well-validated. The PUMA-PEFR model provides more accurate and cost-effective case-finding efficacy than C-PUMA alone in at-risk, undiagnosed COPD patients. These tools can be useful to detect COPD early.
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Affiliation(s)
- Kang-Cheng Su
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Center of Sleep Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Yi-Han Hsiao
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Hsin-Kuo Ko
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Kun-Ta Chou
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Center of Sleep Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Tien-Hsin Jeng
- Medical Department, Ditmanson Medical Foundation, Chia-Yi Christian Hospital, Chia-Yi, Taiwan, ROC
| | - Diahn-Warng Perng
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC.
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Aaron SD, Montes de Oca M, Celli B, Bhatt SP, Bourbeau J, Criner GJ, DeMeo DL, Halpin DMG, Han MK, Hurst JR, Krishnan JK, Mannino D, van Boven JFM, Vogelmeier CF, Wedzicha JA, Yawn BP, Martinez FJ. Early Diagnosis and Treatment of Chronic Obstructive Pulmonary Disease: The Costs and Benefits of Case Finding. Am J Respir Crit Care Med 2024; 209:928-937. [PMID: 38358788 DOI: 10.1164/rccm.202311-2120pp] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Accepted: 02/14/2024] [Indexed: 02/16/2024] Open
Affiliation(s)
- Shawn D Aaron
- The Ottawa Hospital Research Institute, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Maria Montes de Oca
- Universidad Central de Venezuela, Caracas, Venezuela
- Hospital Centro Médico de Caracas, Caracas, Venezuela
| | | | - Surya P Bhatt
- Pulmonary, Allergy and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Jean Bourbeau
- Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Gerard J Criner
- Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - Dawn L DeMeo
- Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - David M G Halpin
- University of Exeter Medical School, University of Exeter, Exeter, United Kingdom
| | - MeiLan K Han
- Division of Pulmonary & Critical Care, University of Michigan, Ann Arbor, Michigan
| | - John R Hurst
- UCL Respiratory, University College London, London, United Kingdom
| | - Jamuna K Krishnan
- Division of Pulmonary and Critical Care, Weill Cornell Medicine, New York, New York
| | - David Mannino
- College of Medicine, University of Kentucky, Lexington, Kentucky
| | - Job F M van Boven
- Department of Clinical Pharmacy & Pharmacology, University Medical Center Groningen, Groningen Research Institute for Asthma and COPD, University of Groningen, Groningen, The Netherlands
| | - Claus F Vogelmeier
- Philipps-Universität Marburg, German Center for Lung Research, Marburg, Germany
| | - Jadwiga A Wedzicha
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Barbara P Yawn
- Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, Minnesota; and
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Lin CH, Cheng SL, Chen CZ, Chen CH, Lin SH, Wang HC. Current Progress of COPD Early Detection: Key Points and Novel Strategies. Int J Chron Obstruct Pulmon Dis 2023; 18:1511-1524. [PMID: 37489241 PMCID: PMC10363346 DOI: 10.2147/copd.s413969] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 07/09/2023] [Indexed: 07/26/2023] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality worldwide, with approximately 70% to 80% of adults with COPD being undiagnosed. Patients with undiagnosed COPD are at increased risk of poor outcomes and a worsened quality of life, making early detection a crucial strategy to mitigate the impact of COPD and reduce the burden on healthcare systems. In the past decade, increased interest has been focused on the development of effective strategies and instrument for COPD early detection. However, identifying undiagnosed cases of COPD is still challenging. Both screening and case-finding approaches have been adopted to identify undiagnosed COPD, with case-finding being recommended by the 2023 Global Initiative for Chronic Obstructive Lung Disease (GOLD) guideline and the updated United States Preventive Services Task Force (USPTF) recommendation. Nonetheless, the approaches, criteria, and instruments used for early detection of COPD are varied. However, advances in the taxonomy and risk factors of COPD are continuously being investigated. It is important to continuously assess the current state of knowledge on COPD early detection, given the challenges associated with identifying undiagnosed COPD. This review aims to highlight recent advances in early detection of COPD. To discuss the current challenge and opportunity in COPD early detection, providing an overview of existing literature on COPD case-finding strategies, including the approaches, criteria for subjects, and instruments. The review also summarizes the current progress in COPD case-findings and proposes a COPD case-finding flowchart as an efficient method for identifying at risk COPD patients.
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Affiliation(s)
- Ching-Hsiung Lin
- Division of Chest Medicine, Changhua Christian Hospital, Changhua, 500, Taiwan
- Institute of Genomics and Bioinformatics, National Chung Hsing University, Taichung, 402, Taiwan
- Ph.D. Program in Translational Medicine, National Chung Hsing University, Taichung, Taiwan
- Department of Recreation and Holistic Wellness, MingDao University, Changhua, Taiwan
| | - Shih-Lung Cheng
- Department of Internal Medicine, Far Eastern Memorial Hospital, Taipei, 220, Taiwan
- Department of Chemical Engineering and Materials Science, Yuan Ze University, Taoyuan, 320, Taiwan
| | - Chiung-Zuei Chen
- Division of Pulmonary Medicine, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chia-Hung Chen
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung, 404, Taiwan
| | - Sheng-Hao Lin
- Division of Chest Medicine, Changhua Christian Hospital, Changhua, 500, Taiwan
| | - Hao-Chien Wang
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, 100, Taiwan
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Hansen MRH, Schmid JM. Screening for impaired pulmonary function using peak expiratory flow: Performance of different interpretation strategies. Respir Med Res 2023; 83:101015. [PMID: 37087903 DOI: 10.1016/j.resmer.2023.101015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 03/29/2023] [Accepted: 03/30/2023] [Indexed: 04/09/2023]
Abstract
BACKGROUND Spirometry is the gold standard for diagnosis of impaired pulmonary function, but is often unavailable in resource-constrained settings. Some authors have suggested using peak expiratory flow (PEF) to screen for impaired pulmonary function when spirometry is unavailable, but with no consensus on how to define abnormally low PEF. Strategies have included cutoffs based on absolute value of PEF, PEF in percent predicted, PEF Z-score, PEF × height-2, and gender-specific cutoffs of absolute PEF. The objective of this paper is to determine the PEF interpretation strategy with the highest predictive ability for low pulmonary function, with spirometry as the gold standard. METHODS We analyzed data on individuals aged 40-79 years in the United States National Health and Nutrition Examination Survey 2007-2012. 6,144 individuals fulfilled inclusion criteria for the main analysis. For each PEF interpretation strategy, we calculated the area under the receiver operating curve (AUC) for the detection of low pulmonary function (defined by FEV1 Z-score < -1.645, < -2, < -2.5 or < -3). RESULTS The AUC was substantially and statistically significantly higher for PEF in percent predicted and PEF Z-score than for absolute value and PEF × height-2, including after stratification by gender. There was no difference in AUC between PEF in percent predicted and PEF Z-score. CONCLUSION If using PEF to screen adults aged 40 years or older for impaired pulmonary function defined by low FEV1 Z-score, basing cutoffs on PEF in percent predicted or PEF Z-score may result in improved predictive ability. As percent predicted is a mathematically simpler term than Z-score, it may be preferable to use cutoffs based on PEF in percent predicted.
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Affiliation(s)
- Martin Rune Hassan Hansen
- Department of Medicine, Randers Regional Hospital, Skovlyvej 15, DK-8930 Randers NØ, Denmark; Environment, Occupation and Health, Department of Public Health, Aarhus University, Bartholins Allé 2, DK-8000 Aarhus C, Denmark; Danish Big Data Centre for Environment and Health (BERTHA), Aarhus University, Frederiksborgvej 399, Postboks 358, DK-4000 Roskilde, Denmark; Department of Infectious Diseases, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, DK-8200 Aarhus N, Denmark.
| | - Johannes Martin Schmid
- Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, DK-8200 Aarhus N, Denmark
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Martins SM, Dickens AP, Salibe-Filho W, Albuquerque Neto AA, Adab P, Enocson A, Cooper BG, Sousa LVA, Sitch AJ, Jowett S, Adams R, Cheng KK, Chi C, Correia-de-Sousa J, Farley A, Gale N, Jolly K, Maglakelidze M, Maghlakelidze T, Stavrikj K, Turner AM, Williams S, Jordan RE, Stelmach R. Accuracy and economic evaluation of screening tests for undiagnosed COPD among hypertensive individuals in Brazil. NPJ Prim Care Respir Med 2022; 32:55. [PMID: 36513683 PMCID: PMC9747958 DOI: 10.1038/s41533-022-00303-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 09/29/2022] [Indexed: 12/15/2022] Open
Abstract
In Brazil, prevalence of diagnosed COPD among adults aged 40 years and over is 16% although over 70% of cases remain undiagnosed. Hypertension is common and well-recorded in primary care, and frequently co-exists with COPD because of common causes such as tobacco smoking, therefore we conducted a cross-sectional screening test accuracy study in nine Basic Health Units in Brazil, among hypertensive patients aged ≥40 years to identify the optimum screening test/combinations to detect undiagnosed COPD. We compared six index tests (four screening questionnaires, microspirometer and peak flow) against the reference test defined as those below the lower limit of normal (LLN-GLI) on quality diagnostic spirometry, with confirmed COPD at clinical review. Of 1162 participants, 6.8% (n = 79) had clinically confirmed COPD. Peak flow had a higher specificity but lower sensitivity than microspirometry (sensitivity 44.3% [95% CI 33.1, 55.9], specificity 95.5% [95% CI 94.1, 96.6]). SBQ performed well compared to the other questionnaires (sensitivity 75.9% [95% CI 65.0, 84.9], specificity 59.2% [95% CI 56.2, 62.1]). A strategy requiring both SBQ and peak flow to be positive yielded sensitivity of 39.2% (95% CI 28.4, 50.9) and specificity of 97.0% (95% CI 95.7, 97.9). The use of simple screening tests was feasible within the Brazilian primary care setting. The combination of SBQ and peak flow appeared most efficient, when considering performance of the test, cost and ease of use (costing £1690 (5554 R$) with 26.7 cases detected per 1,000 patients). However, the choice of screening tests depends on the clinical setting and availability of resources.ISRCTN registration number: 11377960.
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Affiliation(s)
- S M Martins
- Family Medicine, ABC Medical School, Sao Paulo, Brazil
| | - A P Dickens
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Observational and Pragmatic Research Institute, Midview City, Singapore
| | - W Salibe-Filho
- Family Medicine, ABC Medical School, Sao Paulo, Brazil
- Respiratory Division, Hospital das Clínicas, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | | | - P Adab
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK.
| | - A Enocson
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - B G Cooper
- Lung Function & Sleep, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - L V A Sousa
- Family Medicine, ABC Medical School, Sao Paulo, Brazil
| | - A J Sitch
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK
| | - S Jowett
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - R Adams
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - K K Cheng
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - C Chi
- Department of General Practice, Peking University First Hospital, Beijing, China
| | - J Correia-de-Sousa
- International Primary Care Respiratory Group, Edinburgh, UK
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga Portugal, ICVS/3B's, PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - A Farley
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - N Gale
- Health Services Management Centre, School of Social Policy, College of Social Sciences, University of Birmingham, Birmingham, UK
| | - K Jolly
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - M Maglakelidze
- Georgian Respiratory Association, Tbilisi, Georgia
- Petre Shotadze Tbilisi Medical Academy, Tblisi, Georgia
| | - T Maghlakelidze
- Georgian Respiratory Association, Tbilisi, Georgia
- Ivane Javakhishvili Tbilisi State University, Tblisi, Georgia
| | - K Stavrikj
- Center for Family Medicine, Faculty of Medicine, Ss.Cyril and Methodius University in Skopje, Skopje, North Macedonia
| | - A M Turner
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - S Williams
- International Primary Care Respiratory Group, Edinburgh, UK
| | - R E Jordan
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - R Stelmach
- Respiratory Division, Hospital das Clínicas, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
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Accuracy of portable spirometers in the diagnosis of chronic obstructive pulmonary disease A meta-analysis. NPJ Prim Care Respir Med 2022; 32:15. [PMID: 35440665 PMCID: PMC9019105 DOI: 10.1038/s41533-022-00275-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 02/11/2022] [Indexed: 12/03/2022] Open
Abstract
Portable spirometers has been approved for diagnosing chronic obstructive pulmonary disease (COPD). However, their diagnostic accuracy has not been reviewed. Therefore, the purpose of this study was to systematically evaluate the diagnostic value of portable spirometers in detecting COPD. A comprehensive literature search for relevant studies was conducted in PubMed, Embase, CNKI, Wan Fang, and Web of Science databases. Pooled sensitivity, specificity, summary receiver operating characteristic (SROC), area under the curve (AUC), and other related indices were calculated using the bivariate mixed-effect model. Subgroup analysis was performed to explore the source of heterogeneity. Thirty one studies were included in the meta-analysis. The pooled sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic ratio (DOR), SROC, and AUC of the SROC of portable spirometers were 0.85 (0.81–0.88), 0.85 (0.81–0.88), 5.6 (4.4–7.3), 0.18 (0.15–0.22), 31 (21–46) and 0.91 (0.89–0.94), respectively. Among the three commonly used types of portable spirometers, the accuracy of PIKO-6 was higher (0.95) than that of COPD-6 (0.91) and PEF (0.82). Subgroup analysis indicated that the accuracy of a multi-indices portable spirometer was higher than that of a single-index one (P < 0.05). In addition, portable spirometry performed by professional technicians in tertiary hospitals was more accurate than for those conducted by trained technicians in primary care facilities and communities (P < 0.05). Moreover, the accuracy of studies conducted in developing country was superior to developed country (P < 0.05). Portable spirometers have high accuracy in the diagnosis of COPD. Multi-index COPD-6 and PIKO-6 displayed higher accuracy than others. Standardized training of instrument operators should be considered to achieve reliable results.
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Schnieders E, Ünal E, Winkler V, Dambach P, Louis VR, Horstick O, Neuhann F, Deckert A. Performance of alternative COPD case-finding tools: a systematic review and meta-analysis. Eur Respir Rev 2021; 30:200350. [PMID: 34039672 PMCID: PMC9488779 DOI: 10.1183/16000617.0350-2020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 01/20/2021] [Indexed: 11/05/2022] Open
Abstract
RATIONALE Guidelines recommend pre-/post-bronchodilator spirometry for diagnosing COPD, but resource constraints limit the availability of spirometry in primary care in low- and middle-income countries. Although spirometry is the diagnostic gold standard, we shall assess alternative tools for settings without spirometry. METHODS A systematic literature review and meta-analysis was conducted, utilising Cochrane, CINAHL, Google Scholar, PubMed and Web of Science (search cut-off was May 01, 2020). Published studies comparing the accuracy of diagnostic tools for COPD with post-bronchodilator spirometry were considered. Studies without sensitivity/specificity data, without a separate validation sample and outside of primary care were excluded. Sensitivity, specificity and area under the curve (AUC) were assessed. RESULTS Of 7578 studies, 24 were included (14 635 participants). Hand devices yielded a larger AUC than questionnaires. The meta-analysis included 17 studies and the overall AUC of micro-spirometers (0.84, 95% CI 0.80-0.89) was larger when compared to the COPD population screener (COPD-PS) questionnaire (0.77, 95% CI 0.63-0.85) and the COPD diagnostic questionnaire (CDQ) (0.72, 95% CI 0.64-0.78). However, only the difference between micro-spirometers and the CDQ was significant. CONCLUSIONS The CDQ and the COPD-PS questionnaire were approximately equally accurate tools. Questionnaires ensured testing of symptomatic patients, but micro-spirometers were more accurate. A combination could increase accuracy but was not evaluated in the meta-analysis.
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Affiliation(s)
- Elena Schnieders
- Research to Practice Group, HIGH - Heidelberg Institute of Global Health, University Hospital Heidelberg, Heidelberg, Germany
| | - Elyesa Ünal
- Research to Practice Group, HIGH - Heidelberg Institute of Global Health, University Hospital Heidelberg, Heidelberg, Germany
| | - Volker Winkler
- Research to Practice Group, HIGH - Heidelberg Institute of Global Health, University Hospital Heidelberg, Heidelberg, Germany
| | - Peter Dambach
- Research to Practice Group, HIGH - Heidelberg Institute of Global Health, University Hospital Heidelberg, Heidelberg, Germany
| | - Valérie R Louis
- Research to Practice Group, HIGH - Heidelberg Institute of Global Health, University Hospital Heidelberg, Heidelberg, Germany
| | - Olaf Horstick
- Research to Practice Group, HIGH - Heidelberg Institute of Global Health, University Hospital Heidelberg, Heidelberg, Germany
| | - Florian Neuhann
- Research to Practice Group, HIGH - Heidelberg Institute of Global Health, University Hospital Heidelberg, Heidelberg, Germany
- School of Medicine and Clinical Sciences, Levy Mwanawasa Medical University, Lusaka, Zambia
| | - Andreas Deckert
- Research to Practice Group, HIGH - Heidelberg Institute of Global Health, University Hospital Heidelberg, Heidelberg, Germany
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Dickens AP, Fitzmaurice DA, Adab P, Sitch A, Riley RD, Enocson A, Jordan RE. Accuracy of Vitalograph lung monitor as a screening test for COPD in primary care. NPJ Prim Care Respir Med 2020; 30:2. [PMID: 31900421 PMCID: PMC6941963 DOI: 10.1038/s41533-019-0158-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 11/13/2019] [Indexed: 11/25/2022] Open
Abstract
Microspirometry may be useful as the second stage of a screening pathway among patients reporting respiratory symptoms. We assessed sensitivity and specificity of the Vitalograph® lung monitor compared with post-bronchodilator confirmatory spirometry (ndd Easy on-PC) among primary care chronic obstructive pulmonary disease (COPD) patients within the Birmingham COPD cohort. We report a case-control analysis within 71 general practices in the UK. Eligible patients were aged ≥40 years who were either on a clinical COPD register or reported chronic respiratory symptoms on a questionnaire. Participants performed pre- and post-bronchodilator microspirometry, prior to confirmatory spirometry. Out of the 544 participants, COPD was confirmed in 337 according to post-bronchodilator confirmatory spirometry. Pre-bronchodilator, using the LLN as a cut-point, the lung monitor had a sensitivity of 50.5% (95% CI 45.0%, 55.9%) and a specificity of 99.0% (95% CI 96.6%, 99.9%) in our sample. Using a fixed ratio of FEV1/FEV6 < 0.7 to define obstruction in the lung monitor, sensitivity increased (58.8%; 95% CI 53.0, 63.8) while specificity was virtually identical (98.6%; 95% CI 95.8, 99.7). Within our sample, the optimal cut-point for the lung monitor was FEV1/FEV6 < 0.78, with sensitivity of 82.8% (95% CI 78.3%, 86.7%) and specificity of 85.0% (95% CI 79.4%, 89.6%). Test performance of the lung monitor was unaffected by bronchodilation. The lung monitor could be used in primary care without a bronchodilator using a simple ratio of FEV1/FEV6 as part of a screening pathway for COPD among patients reporting respiratory symptoms.
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Affiliation(s)
- A P Dickens
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK.
| | - D A Fitzmaurice
- Warwick Medical School - Health Sciences, University of Warwick, Coventry, UK
| | - P Adab
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK.
| | - A Sitch
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - R D Riley
- Centre for Prognosis Research, Research Institute for Primary Care and Health Sciences, Keele University, Keele, UK
| | - A Enocson
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - R E Jordan
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
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Ronaldson SJ, Dyson L, Clark L, Hewitt CE, Torgerson DJ, Cooper BG, Kearney M, Laughey W, Raghunath R, Steele L, Rhodes R, Adamson J. The impact of lung function case-finding tests on smoking behaviour: A nested randomised trial within a case-finding cohort. Health Sci Rep 2018; 1:e41. [PMID: 30623078 PMCID: PMC6266471 DOI: 10.1002/hsr2.41] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 03/10/2018] [Accepted: 03/29/2018] [Indexed: 11/15/2022] Open
Abstract
RATIONALE AIMS AND OBJECTIVES Increasing awareness of people's lung health through the use of lung function tests or symptom-based questionnaires is a potential method to aid smoking cessation. We investigated the impact of case-finding lung function tests for chronic obstructive pulmonary disease on smoking behaviour. METHODS Our trial used a novel waiting list randomised controlled trial design, nested within a case-finding cohort study. The cohort comprised current smokers aged 35 years or more, from general practices in Yorkshire and Humberside, who were randomised to receive lung function tests (spirometry, microspirometry, peak flow meter measurement, and a WheezoMeter) and case-finding questionnaires either immediately ("tests now") or later ("waiting list" control). Outcome measures included self-reported smoking cessation and number of cigarettes smoked at follow-up (at 2, 3, or 6 months after randomisation, depending on study site), with 409 participants included in the primary analysis. RESULTS Six hundred seventy-four participants were randomised using stratified block randomisation to the 2 groups (340 to "tests now" and 334 to "waiting list"), with 409 included in the primary analysis (194 in "tests now" and 215 in "waiting list" groups). Smoking cessation at follow-up was very similar across groups (8.8% in the "tests now" group, compared with 9.2% in the "waiting list" group). Completing case-finding lung function tests did not significantly impact smoking cessation (OR 1.00, 95% CI, 0.57-1.77, adjusting for age, sex, baseline number of cigarettes smoked, and study site). A sensitivity analysis, assuming that participants with missing data were still smoking, gave similar results (OR 0.86, 95% CI, 0.47-1.56). Analysis of the number of cigarettes smoked at follow-up using negative binomial regression adjusting for the same factors above gave an incidence rate ratio of 0.95 (95% CI, 0.88-1.03). CONCLUSIONS There is no evidence from this trial of an effect of lung function tests on smoking cessation among a population of smokers aged 35 years or over. Indeed, when assuming that those with missing data were smokers, a slightly lower odds of smoking cessation was observed in the "test now" group compared with the "waiting list" group.
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Affiliation(s)
| | - Lisa Dyson
- York Trials Unit, Department of Health SciencesUniversity of YorkYorkUK
| | - Laura Clark
- York Trials Unit, Department of Health SciencesUniversity of YorkYorkUK
| | | | | | - Brendan G. Cooper
- Lung Function and SleepQueen Elizabeth Hospital BirminghamBirminghamUK
- University of BirminghamBirminghamUK
| | | | | | | | | | | | - Joy Adamson
- Institute of Health and SocietyNewcastle UniversityNewcastle upon TyneUK
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