Spyratos Dionisios, Haidich Anna-Bettina, Chloros Diamantis, Michalopoulou Dionisia, Sichletidis Lazaros
Pulmonary Department, Aristotle University of Thessaloniki, "G. Papanikolaou" Hospital, Exohi, Greece.
Respiration. 2017;93(2):83-89. doi: 10.1159/000453586. Epub 2017 Jan 5.
Even though the diagnosis of chronic obstructive pulmonary disease (COPD) is easy and based mainly on spirometry and symptoms, the prevalence of underdiagnosis is extremely high. The use of simple screening tools (e.g., questionnaires, hand-held spirometers) has been proved to be a simple method for case finding of COPD. Nevertheless the most appropriate target group of the general population has not been specified yet.
The aim of the present study was to compare 3 screening questionnaires among smokers aged >40 years in the primary care setting.
We excluded all subjects with a previous medical diagnosis of bronchial asthma or chronic pulmonary disease other than COPD. All participants were in a stable clinical condition, filled in the International Primary Care Airways Group (IPAG) questionnaire, the COPD Population Screener (COPD-PS) questionnaire, and the Lung Function Questionnaire (LFQ) and underwent spirometry. Medical diagnosis of COPD was established by an experienced pulmonologist.
We studied 3,234 subjects during a 3.5-year period. COPD prevalence was 10.9% (52.1% underdiagnosis). All 3 questionnaires showed extremely high negative predictive values (94-96%), so in this case the diagnosis of COPD could be safely excluded. The area under the curve was similar across the 3 questionnaires (AUCROC: 0.794-0.809). The COPD-PS questionnaire demonstrated the highest positive predictive value (41%) compared to the other 2. On the other hand, the IPAG questionnaire and LFQ demonstrated higher sensitivities than COPD-PS resulting in lower percentages of missed cases.
Three validated screening questionnaires for COPD demonstrated different diagnostic characteristics.
尽管慢性阻塞性肺疾病（COPD）的诊断并不困难，主要基于肺功能测定和症状，但漏诊率极高。使用简单的筛查工具（如问卷、手持式肺功能仪）已被证明是一种简单的COPD病例发现方法。然而，尚未明确一般人群中最合适的目标群体。
本研究的目的是在基层医疗环境中比较3种筛查问卷在40岁以上吸烟者中的应用。
我们排除了所有先前被诊断患有支气管哮喘或除COPD以外的慢性肺部疾病的受试者。所有参与者临床状况稳定，填写了国际基层医疗气道组织（IPAG）问卷、COPD人群筛查问卷（COPD-PS）和肺功能问卷（LFQ），并接受了肺功能测定。COPD的医学诊断由经验丰富的肺科医生确定。
在3.5年的时间里，我们研究了3234名受试者。COPD患病率为10.9%（漏诊率为52.1%）。所有3种问卷均显示出极高的阴性预测值（94%-96%），因此在这种情况下可以安全地排除COPD诊断。3种问卷的曲线下面积相似（AUCROC：0.794-0.809）。与其他2种问卷相比，COPD-PS问卷显示出最高的阳性预测值（41%）。另一方面，IPAG问卷和LFQ显示出比COPD-PS更高的敏感性，导致漏诊病例的百分比更低。
三种经过验证的COPD筛查问卷显示出不同的诊断特征。
