Kjeldgaard Peter, Lykkegaard Jesper, Spillemose Heidi, Ulrik Charlotte Suppli
Department of Respiratory Medicine, Hvidovre Hospital, Hvidovre.
Research Unit of General Practice, University of Southern Denmark, Odense.
Int J Chron Obstruct Pulmon Dis. 2017 Aug 4;12:2323-2331. doi: 10.2147/COPD.S136244. eCollection 2017.
Early detection of COPD may reduce the future burden of the disease. We aimed to investigate whether prescreening with a COPD-6 screening device (measuring FEV and FEV) facilitates early detection of COPD in primary care.
In primary care, individuals at high risk of COPD (ie, age ≥35 years, relevant exposure, and at least one respiratory symptom) and no previous diagnosis of obstructive lung disease were examined with a COPD-6 screening device. In prioritized order, the criteria for proceeding to confirmatory spirometry were FEV/FEV <0.7, FEV <80%pred, or clinical suspicion of COPD regardless of test result (medical doctor's [MD] decision). Based on spirometry, including bronchodilator (BD) reversibility test, individuals were classified as COPD (post-BD FEV/FVC <0.70), asthma (ΔFEV ≥0.50 L), or no obstructive lung disease.
A total of 2,990 subjects (54% men, mean age 59 years, and mean 28 pack-years) were enrolled, of whom 949 (32%) proceeded from COPD-6 screening to confirmative spirometry based on the following criteria: 510 (54%) FEV/FEV <0.70, 382 (40%) FEV <80%pred, and 57 (6%) MD decision. Following confirmative spirometry, the 949 individuals were diagnosed as having COPD (51%), asthma (3%), and no obstructive lung disease (45%). COPD was diagnosed in 487 (16%) of the enrolled subjects in whom confirmative spirometry was performed in 69% based on FEV/FEV <0.7 and in 29% based on FEV ≤80%pred.
Prescreening with the COPD-6 device showed acceptable specificity for the selection of subjects for diagnostic spirometry and is likely to be a useful alternative to current practice in primary care.
慢性阻塞性肺疾病（COPD）的早期检测可减轻该疾病未来的负担。我们旨在研究使用COPD - 6筛查设备（测量第一秒用力呼气容积[FEV₁]和用力肺活量[FVC]）进行预筛查是否有助于在初级保健中早期检测COPD。
在初级保健中，对COPD高风险个体（即年龄≥35岁、有相关暴露史且至少有一种呼吸道症状）且既往无阻塞性肺疾病诊断的患者，使用COPD - 6筛查设备进行检查。按照优先顺序，进行确诊性肺功能测定的标准为FEV₁/FVC <0.7、FEV₁<80%预计值，或无论检测结果如何临床怀疑患有COPD（由医生[MD]决定）。根据肺功能测定结果，包括支气管扩张剂（BD）可逆性试验，将个体分为COPD（支气管扩张剂后FEV₁/FVC <0.70）、哮喘（FEV₁增加量≥0.50 L）或无阻塞性肺疾病。
共纳入2990名受试者（54%为男性，平均年龄59岁，平均吸烟史28包年），其中949名（32%）根据以下标准从COPD - 6筛查进入确诊性肺功能测定：510名（54%）FEV₁/FVC <0.70，382名（40%）FEV₁<80%预计值，57名（6%）由医生决定。经过确诊性肺功能测定后，这949名个体被诊断为患有COPD（51%）、哮喘（3%）和无阻塞性肺疾病（45%）。在进行确诊性肺功能测定的纳入受试者中，487名（16%）被诊断为COPD，其中69%是基于FEV₁/FVC <0.7，29%是基于FEV₁≤80%预计值。
使用COPD - 6设备进行预筛查对选择进行诊断性肺功能测定的受试者显示出可接受的特异性，并且可能是初级保健中当前做法的一种有用替代方法。
