Instituto de Investigación Hospital Universitario de la Princesa, Universidad Autónoma de Madrid, Madrid, Sociedad Española de Neumología y Cirugía Torácica, Barcelona.
Health Care Center Francia, Fuenlabrada, Madrid.
Int J Tuberc Lung Dis. 2018 Jan 1;22(1):106-111. doi: 10.5588/ijtld.17.0334.
Underdiagnosis of chronic obstructive pulmonary disease (COPD) is common. We aimed to assess the effectiveness of using the Chronic Obstructive Pulmonary Disease-Population Screener (COPD-PS) questionnaire with pre-bronchodilator (BD) peak expiratory flow (PEF) measurements as a case-finding strategy for COPD in primary care.
This was a two-stage, cross-sectional study comprising a population survey in a primary care population aged 35 years without previous COPD, followed by a validation study using COPD-PS 4 or PEF 2.2 l/s·m2, and confirmed by spirometry (post-BD forced expiratory volume in 1 s/forced vital capacity [FEV1/FVC] <0.70). The predictive capacity of the strategy was assessed in a case-control sub-study.
Of a total of 10 071 individuals, 6969 (69.2%) participants were included. Both tests were positive in 4.3% subjects, PEF only in 2.1% and COPD-PS only in 5.1%. Of the 802 with positive screening results, COPD was confirmed using spirometry in 130, accounting for 1.9% of all participants and 16.2% of those who tested positive on COPD-PS or PEF. Among the 130 true-positives, the mean score for the COPD-PS questionnaire was 5.1 l/s·m2 (± standard deviation [SD] 1.7) and 1.9 l/s·m2 (±SD 0.8) for pre-BD PEF, both significantly worse than in the 672 false-positives. The combined use of both screening tests had a sensitivity of 67.5%, a specificity of 71.3% and a diagnostic accuracy of 69.6%.
Case finding for COPD using COPD-PS + PEF led to a 90% reduction in the number of spirometry tests performed.
慢性阻塞性肺疾病（COPD）的漏诊较为常见。本研究旨在评估在初级保健中使用慢性阻塞性肺病人群筛查问卷（COPD-PS）联合预支气管扩张剂（BD）呼气峰流速（PEF）作为 COPD 病例发现策略的有效性。
这是一项两阶段、横断面研究，包括一项初级保健人群中年龄大于等于 35 岁且无既往 COPD 患者的人群调查，随后使用 COPD-PS 大于等于 4 分或 PEF 小于 2.2 l/s·m2 进行验证研究，并通过 BD 后用力肺活量/用力肺活量（FEV1/FVC）小于 0.70 进行确认。该策略的预测能力在病例对照子研究中进行了评估。
共纳入 10071 名患者，其中 6969 名（69.2%）患者符合条件。4.3%的患者两种检查均阳性，2.1%的患者仅 PEF 阳性，5.1%的患者仅 COPD-PS 阳性。在 802 例筛查结果阳性的患者中，有 130 例通过肺功能检查确诊为 COPD，占所有患者的 1.9%，占 COPD-PS 或 PEF 阳性患者的 16.2%。在 130 例真阳性患者中，COPD-PS 问卷的平均得分为 5.1 l/s·m2（±标准差 1.7），BD 前 PEF 为 1.9 l/s·m2（±标准差 0.8），均显著差于 672 例假阳性患者。两种筛查试验联合使用的敏感性为 67.5%，特异性为 71.3%，诊断准确性为 69.6%。
使用 COPD-PS + PEF 进行 COPD 病例发现可使肺功能检查数量减少 90%。
