Centre for Chronic Conditions and Injuries (CCCI), Public Health Foundation of India, Gurgaon, India.
Institute of Health Transformation, Faculty of Health, Deakin University, Burwood, Melbourne, Australia.
Int J Chron Obstruct Pulmon Dis. 2021 Apr 29;16:1183-1192. doi: 10.2147/COPD.S293577. eCollection 2021.
Undiagnosed Chronic Obstructive Pulmonary Disease (COPD) results in high morbidity, disability and mortality in India. Effective strategies for active COPD screening in community settings are needed to increase early identification, risk reduction and timely management. The objective of this study was to test the diagnostic accuracy of a sequential two-step screening strategy to detect COPD, implemented by community health workers (CHWs), among adults aged ≥40 years in a rural area of North India.
Trained CHWs screened all consenting (n=3256) eligible adults in two villages using the Lung Function Questionnaire (LFQ) to assess their COPD risk and conducted pocket spirometry on 268 randomly selected (132 with high risk ie LFQ score ≤18 and 136 with low risk ie LFQ score >18) individuals. Subsequently, trained researchers conducted post-bronchodilator spirometry on these randomly selected individuals using a diagnostic quality spirometer and confirmed the COPD diagnosis according to the Global Initiative for Obstructive Lung Disease (GOLD) criteria (FEV/FVC ratio <0.7).
This strategy of using LFQ followed by pocket spirometry was sensitive (78.6%) and specific (78.8%), with a positive predictive value of 66% and negative predictive value of 88%. It could accurately detect 67% of GOLD Stage 1, 78% of GOLD Stage 2, 82% of GOLD Stage 3 and 100% of GOLD Stage 4 individuals with airflow limitation.
COPD can be accurately detected by trained CHWs using a simple sequential screening strategy. This can potentially contribute to accurate assessment of COPD and thus its effective management in low-resource settings.
在印度，未确诊的慢性阻塞性肺疾病（COPD）会导致高发病率、残疾和死亡率。需要在社区环境中采取有效的 COPD 主动筛查策略，以提高早期识别、降低风险和及时管理的能力。本研究的目的是检验由社区卫生工作者（CHWs）实施的两步序贯筛查策略在印度北部农村地区检测 COPD 的诊断准确性。
经过培训的 CHWs 使用肺功能问卷（LFQ）对两个村庄中所有符合条件（n=3256）的成年进行筛查，以评估他们的 COPD 风险，并对 268 名随机选择的个体（132 名高风险，即 LFQ 评分≤18，136 名低风险，即 LFQ 评分>18）进行口袋式肺量计检查。随后，经过培训的研究人员使用诊断质量的肺量计对这些随机选择的个体进行支气管扩张剂后肺量计检查，并根据全球倡议对阻塞性肺疾病（GOLD）标准（FEV/FVC 比值<0.7）对 COPD 进行确诊。
这种使用 LFQ 后进行口袋式肺量计检查的策略具有较高的敏感性（78.6%）和特异性（78.8%），阳性预测值为 66%，阴性预测值为 88%。它可以准确检测到 67%的 GOLD 1 期、78%的 GOLD 2 期、82%的 GOLD 3 期和 100%的 GOLD 4 期气流受限患者。
经过培训的 CHWs 可以使用简单的序贯筛查策略准确检测 COPD。这可能有助于在资源有限的环境中对 COPD 进行准确评估，从而有效管理 COPD。
