van Schayck Constant P, Halbert Ronald J, Nordyke Robert J, Isonaka Sharon, Maroni Jaman, Nonikov Dmitry
Department of General Practice, Research Institute Caphri, University of Maastricht, Maastricht, Netherlands.
Respirology. 2005 Jun;10(3):323-33. doi: 10.1111/j.1440-1843.2005.00720.x.
Underdiagnosis of COPD is widespread, at least in part due to underuse of spirometry. Symptom-based questionnaires may be helpful as an adjunct to spirometry. The aim of this study was to determine which types of questions might aid in identifying COPD.
Questionnaires were identified by literature review and input from a multinational advisory board of primary care providers. Questions were placed into groups and evaluated with respect to their ability to perform in two scenarios: (i) to identify persons with COPD from a general population (Case-finding scenario); and (ii) to distinguish persons with COPD from those with asthma (Differential Diagnosis scenario). Questions were retrospectively validated using the Third National Health and Nutrition Examination Survey data. Potential predictive ability was examined in bivariate and multivariate frameworks.
Four published question sets and six additional documents were included. There was agreement in the use of smoking and symptom-based questions, but important differences in the use of demographic, personal history and other information. Most question types had significant bivariate relationships with airway obstruction. In multivariate analysis, age, BMI, smoking status and pack-years, symptoms (cough, phlegm, dyspnoea, wheeze), and prior diagnosis consistent with asthma or COPD all showed significant ability to discriminate between persons with and without obstruction in a general population.
Simple self-administered questionnaires can be used to identify persons for whom spirometric testing may be especially appropriate. Development of such questionnaires will require additional study, including prospective validation of items in an appropriate clinical setting and policy recommendations on the use of these tools.
慢性阻塞性肺疾病（COPD）的漏诊情况普遍存在，至少部分原因是肺活量测定法使用不足。基于症状的问卷作为肺活量测定法的辅助手段可能会有所帮助。本研究的目的是确定哪些类型的问题有助于识别COPD。
通过文献综述和来自初级保健提供者的跨国咨询委员会的意见确定问卷。将问题分组，并评估它们在两种情况下的表现能力：（i）从普通人群中识别COPD患者（病例发现情况）；以及（ii）区分COPD患者和哮喘患者（鉴别诊断情况）。使用第三次全国健康和营养检查调查数据对问题进行回顾性验证。在双变量和多变量框架中检查潜在的预测能力。
纳入了四个已发表的问题集和另外六份文件。在使用吸烟和基于症状的问题上存在共识，但在人口统计学、个人病史和其他信息的使用上存在重要差异。大多数问题类型与气道阻塞有显著的双变量关系。在多变量分析中，年龄、体重指数、吸烟状况和吸烟包年数、症状（咳嗽、咳痰、呼吸困难、喘息）以及先前与哮喘或COPD一致的诊断在普通人群中均显示出区分有无气道阻塞患者的显著能力。
简单的自我管理问卷可用于识别可能特别适合进行肺活量测定的人群。开发此类问卷需要进一步研究，包括在适当的临床环境中对项目进行前瞻性验证以及关于使用这些工具的政策建议。
