Evidera, Bethesda, MD, USA.
Olmsted Medical Center, Rochester, MN, USA.
NPJ Prim Care Respir Med. 2015 Apr 16;25:15024. doi: 10.1038/npjpcrm.2015.24.
Many cases of chronic obstructive pulmonary disease (COPD) are diagnosed only after significant loss of lung function or during exacerbations.
This study is part of a multi-method approach to develop a new screening instrument for identifying undiagnosed, clinically significant COPD in primary care.
Subjects with varied histories of COPD diagnosis, risk factors and history of exacerbations were recruited through five US clinics (four pulmonary, one primary care). Phase I: Eight focus groups and six telephone interviews were conducted to elicit descriptions of risk factors for COPD, recent or historical acute respiratory events, and symptoms to inform the development of candidate items for the new questionnaire. Phase II: A new cohort of subjects participated in cognitive interviews to assess and modify candidate items. Two peak expiratory flow (PEF) devices (electronic, manual) were assessed for use in screening.
Of 77 subjects, 50 participated in Phase I and 27 in Phase II. Six themes informed item development: exposure (smoking, second-hand smoke); health history (family history of lung problems, recurrent chest infections); recent history of respiratory events (clinic visits, hospitalisations); symptoms (respiratory, non-respiratory); impact (activity limitations); and attribution (age, obesity). PEF devices were rated easy to use; electronic values were significantly higher than manual (P<0.0001). Revisions were made to the draft items on the basis of cognitive interviews.
Forty-eight candidate items are ready for quantitative testing to select the best, smallest set of questions that, together with PEF, can efficiently identify patients in need of diagnostic evaluation for clinically significant COPD.
许多慢性阻塞性肺疾病（COPD）病例仅在肺功能明显丧失或在加重期才被诊断出来。
本研究是一种多方法方法的一部分，旨在开发一种新的筛选工具，用于在初级保健中识别未诊断的、具有临床意义的 COPD。
通过美国五家诊所（四家肺病科，一家初级保健科）招募了具有不同 COPD 诊断、危险因素和加重史的患者。第一阶段：进行了八次焦点小组和六次电话访谈，以了解 COPD 的危险因素、近期或历史上的急性呼吸道事件以及症状描述，为新问卷的候选项目的开发提供信息。第二阶段：一组新的患者参加认知访谈，以评估和修改候选项目。评估了两种峰流速（PEF）设备（电子的、手动的）用于筛查。
在 77 名患者中，50 名参加了第一阶段，27 名参加了第二阶段。六个主题为项目开发提供了信息：暴露（吸烟、二手烟）；健康史（肺部问题家族史、反复呼吸道感染）；近期呼吸道事件史（就诊、住院）；症状（呼吸、非呼吸）；影响（活动受限）；归因（年龄、肥胖）。PEF 设备被评为易于使用；电子值明显高于手动值（P<0.0001）。根据认知访谈对草案项目进行了修订。
48 个候选项目已准备好进行定量测试，以选择最佳、最小的问题集，与 PEF 一起，可有效地识别需要进行具有临床意义的 COPD 诊断评估的患者。
