Chen Feng, Nie Qingrong, Han Xuefeng, Li Chunjuan, Liu Qimeng, Xu Feifei, Zhang Li, Qiao Le, Li Maoxin, Zhang Ying, Wang Haiyan
Liangxiang Teaching Hospital Affiliated to Capital Medical University, Beijing, China.
Changyang Community Health Service Center, Fangshan District, Beijing, China.
BMC Pulm Med. 2025 Feb 3;25(1):57. doi: 10.1186/s12890-025-03515-1.
Portable spirometers and chronic obstructive pulmonary disease (COPD) diagnostic questionnaires are commonly used for screening patients with COPD in primary healthcare institutions, but their accuracy is often inadequate. This study aimed to explore the accuracy of combining these two tools in screening for COPD.
Participants aged ≥ 40 years were recruited from primary healthcare institutions between July 2022 and July 2023. All participants completed COPD diagnostic questionnaires (CDQs) and pulmonary function tests including pre and post bronchodilator maneuvers using a portable spirometer at primary healthcare institutions and a conventional spirometer at a tertiary hospital. COPD was diagnosed based on the forced expiratory volume/forced vital capacity (FEV/FVC) ratio measured by the conventional spirometer after administration of 400 µg of salbutamol sulfate. An FEV/FVC ratio of < 70% indicated COPD, while an FEV1/FVC ratio of ≥ 70% was classified as non-COPD. The sensitivity and specificity of combining the portable spirometer and CDQ for COPD screening were statistically analyzed. Receiver operating characteristic (ROC) curves were employed to compare the efficacy of the portable spirometer, CDQ, and their combination in diagnosing COPD.
Of the 2,120 participants, 264 were newly diagnosed with COPD. Among the non-COPD population, 264 participants were matched by age, sex, and BMI to form the non-COPD group. The sensitivity and specificity of the combination of the portable spirometer and CDQ in diagnosing COPD were 96.6% (95% confidence interval [CI]: 0.934-0.983) and 79.9% (95% CI: 0.745-0.845), respectively, significantly higher than those with the use of either method alone (p < 0.05). The area under the ROC curve for the combined diagnosis of COPD was 0.994 (95% CI: 0.983-0.999), with a Jordan index of 0.765.
Our findings suggest that combining the portable spirometer with the CDQ enhances COPD detection and is a valuable approach for implementation in primary healthcare institutions.
This study has been registered in national medical research registration and filing information system of China, www.medicalresearch.org.cn , Trail registration number: MR-11-23-020214.
便携式肺活量计和慢性阻塞性肺疾病（COPD）诊断问卷常用于基层医疗机构对COPD患者的筛查，但它们的准确性往往不足。本研究旨在探讨将这两种工具结合用于COPD筛查的准确性。
2022年7月至2023年7月期间，从基层医疗机构招募年龄≥40岁的参与者。所有参与者均完成COPD诊断问卷（CDQ）以及肺功能测试，包括在基层医疗机构使用便携式肺活量计和在三级医院使用传统肺活量计进行支气管扩张剂使用前后的测试。根据给予400μg硫酸沙丁胺醇后使用传统肺活量计测量的用力呼气量/用力肺活量（FEV/FVC）比值诊断COPD。FEV/FVC比值<70%表明患有COPD，而FEV1/FVC比值≥70%则归类为非COPD。对便携式肺活量计和CDQ联合用于COPD筛查的敏感性和特异性进行了统计学分析。采用受试者操作特征（ROC）曲线比较便携式肺活量计、CDQ及其联合使用在诊断COPD方面的效果。
在2120名参与者中，有264人被新诊断为COPD。在非COPD人群中，按年龄、性别和BMI匹配264名参与者组成非COPD组。便携式肺活量计和CDQ联合诊断COPD的敏感性和特异性分别为96.6%（95%置信区间[CI]：0.934 - 0.983）和79.9%（95%CI：0.745 - 0.845），显著高于单独使用任何一种方法（p<0.05）。COPD联合诊断的ROC曲线下面积为0.994（95%CI：0.983 - 0.999），约登指数为0.765。
我们的研究结果表明，将便携式肺活量计与CDQ相结合可提高COPD检测率，是一种在基层医疗机构实施的有价值方法。
本研究已在中国国家医学研究登记备案信息系统（www.medicalresearch.org.cn）注册，试验注册号：MR - 11 - 23 - 020214。
