Thorn Jörgen, Tilling Björn, Lisspers Karin, Jörgensen Leif, Stenling Anna, Stratelis Georgios
Sahlgrenska School of Public Health and Community Medicine, Section of Primary Health Care, University of Gothenburg, Sweden.
Prim Care Respir J. 2012 Jun;21(2):159-66. doi: 10.4104/pcrj.2011.00104.
The importance of identifying chronic obstructive pulmonary disease (COPD) at an early stage is recognised. Improved and easily accessible identification of individuals at risk of COPD in primary care is needed to select patients for spirometry more accurately.
To explore whether use of a mini-spirometer can predict a diagnosis of COPD in patients at risk of COPD in primary care, and to assess its cost-effectiveness in detecting patients with COPD.
Primary care patients aged 45-85 years with a smoking history of >15 pack-years were selected. Data were collected on the Clinical COPD Questionnaire (CCQ), Medical Research Council (MRC) dyspnoea scale and smoking habits. Lung function (forced expiratory volume in 1 and 6 s; FEV1 and FEV6, respectively) was measured by mini-spirometer (copd-6), followed by diagnostic standard spirometry (COPD diagnosis post-bronchodilation ratio of FEV1 to forced vital capacity (FVC) <0.7). Time consumed was recorded. Univariate logistic regression and receiver operating characteristic (ROC) curves were used.
A total of 305 patients (57% females) of mean (SD) age 61.2 (8.4) years, mean (SD) total CCQ 1.0 (0.8) and mean (SD) MRC 0.8 (0.8) were recruited from 21 centres. COPD was diagnosed in 77 patients (25.2%) by standard diagnostic spirometry. Using the copd-6 device, mean (SD) FEV1/FEV6 was 68 (8)% in patients with COPD and 78 (10)% in patients without COPD. Sensitivity and specificity at a FEV1/FEV6 cut-off of 73% were 79.2% and 80.3%, respectively. The area under the ROC curve was 0.84. Screening with the copd-6 device significantly predicted COPD. Gender, CCQ, and MRC were not found to predict COPD.
Using the copd-6 as a pre-screening device, the rate of COPD diagnoses by standard diagnostic spirometry increased from 25.2% to 79.2%. Although the sensitivity and specificity of the copd-6 could be improved, it might be an important device for prescreening of COPD in primary care and may reduce the number of unnecessary spirometric tests performed.
早期识别慢性阻塞性肺疾病（COPD）的重要性已得到认可。需要在初级保健中改进并更易于获取对COPD高危个体的识别方法，以便更准确地选择患者进行肺功能测定。
探讨使用微型肺活量计能否预测初级保健中COPD高危患者的COPD诊断，并评估其在检测COPD患者方面的成本效益。
选取年龄在45 - 85岁、吸烟史超过15包年的初级保健患者。收集临床COPD问卷（CCQ）、医学研究委员会（MRC）呼吸困难量表和吸烟习惯的数据。通过微型肺活量计（copd - 6）测量肺功能（分别为第1秒和第6秒用力呼气量；FEV1和FEV6），随后进行诊断性标准肺功能测定（支气管扩张后FEV1与用力肺活量（FVC）的比值<0.7作为COPD诊断标准）。记录耗时情况。采用单因素逻辑回归和受试者工作特征（ROC）曲线进行分析。
从21个中心招募了305例患者（57%为女性），平均（标准差）年龄61.2（8.4）岁，平均（标准差）CCQ总分1.0（0.8），平均（标准差）MRC评分为0.8（0.8）。通过标准诊断性肺功能测定，77例患者（25.2%）被诊断为COPD。使用copd - 6设备时，COPD患者的平均（标准差）FEV1/FEV6为68（8）%，非COPD患者为78（10）%。在FEV1/FEV6临界值为73%时，敏感性和特异性分别为79.2%和80.3%。ROC曲线下面积为0.84。使用copd - 6设备进行筛查能显著预测COPD。未发现性别、CCQ和MRC可预测COPD。
将copd - 6用作预筛查设备后，通过标准诊断性肺功能测定诊断COPD的比例从25.2%提高到了79.2%。尽管copd - 6的敏感性和特异性有待提高，但它可能是初级保健中COPD预筛查的重要设备，并且可能减少不必要的肺功能测定检查次数。
