Lorenzo M, Delpeyroux S, Dupre V
Département de médecine générale, UFR de médecine, université de Strasbourg, Strasbourg, France; Maison de santé pluriprofessionnelle Guillaume Tell, 2, place Guillaume-Tell, 68100 Mulhouse, France.
Département de médecine générale, UFR de médecine, université de Strasbourg, Strasbourg, France.
Rev Mal Respir. 2020 Oct;37(8):624-632. doi: 10.1016/j.rmr.2020.06.011. Epub 2020 Jul 14.
The Haute Autorité de santé (HAS) in France offers a patient self-questionnaire to optimize targeted chronic obstructive pulmonary disease (COPD) screening among at-risk patients in primary care. It includes smoking but does not have a threshold for pack-years (PY) smoked. The objective of this study was to compare the positive predictive values (PPV) of the HAS self-questionnaire alone and with the addition of a PY threshold.
This was a prospective pilot study conducted in a multi-professional health centre. Identification among smoking or former smoking patients without a COPD diagnosis of subjects with a positive HAS self-questionnaire, a positive PY threshold, or both. We performed spirometry after bronchodilatation.
Thirty-five people were included in the study. All 35 had a positive PY threshold. The HAS questionnaire was positive for 22 of them (62.9%). Spirometry diagnosed 18 participants with COPD (51%). The PPV for the HAS questionnaire was 0.41 and the PPV for the HAS+PY questionnaire was 0.51. There was no statistically significant difference between these two PPVs (P=0.3692).
The addition of a PY threshold to the HAS self-questionnaire may allow better targeting of the population at risk of developing COPD.
法国卫生高级管理局（HAS）提供了一份患者自我调查问卷，以优化基层医疗中高危患者的慢性阻塞性肺疾病（COPD）针对性筛查。该问卷包含吸烟情况，但未设定吸烟包年数（PY）的阈值。本研究的目的是比较仅使用HAS自我调查问卷与增加PY阈值后的阳性预测值（PPV）。
这是一项在多专业健康中心进行的前瞻性试点研究。在未诊断出患有COPD的吸烟或既往吸烟患者中，识别出HAS自我调查问卷呈阳性、PY阈值呈阳性或两者均呈阳性的受试者。我们在支气管扩张后进行了肺功能测定。
35人纳入研究。所有35人的PY阈值均为阳性。其中22人（62.9%）的HAS问卷呈阳性。肺功能测定诊断出18名参与者患有COPD（51%）。HAS问卷的PPV为0.41，HAS+PY问卷的PPV为0.51。这两个PPV之间无统计学显著差异（P=0.3692）。
在HAS自我调查问卷中增加PY阈值可能会更好地针对有患COPD风险的人群。
