Development and validation of the Salzburg COPD-screening questionnaire (SCSQ): a questionnaire development and validation study

Abstract

Chronic obstructive pulmonary disease prevalence rates are still high. However, the majority of subjects are not diagnosed. Strategies have to be implemented to overcome the problem of under-diagnosis. Questionnaires could be used to pre-select subjects for spirometry and thereby help reducing under-diagnosis. We report a brief, simple, self-administrable and validated chronic obstructive pulmonary disease questionnaire to increase the pre-test probability for chronic obstructive pulmonary disease diagnosis in subjects undergoing confirmatory spirometry. In 2005, we completed the Austrian Burden of Obstructive Lung Disease-study in 1258 subjects aged >40 years. Post-bronchodilator spirometry was performed, and non-reversible airflow limitation defined by FEV1/FVC ratio below the lower limit of normal. Questions from the Salzburg chronic obstructive pulmonary disease screening-questionnaire were selected using a logistic regression model, and risk scores were based on regression-coefficients. A training sub-sample (n = 800) was used to create the score, and a test sub-sample (n = 458) was used to test it. In 2008, an external validation study was done, using the same protocol in 775 patients from primary care. The Salzburg chronic obstructive pulmonary disease screening questionnaire was composed of items related to “breathing problems”, “wheeze”, “cough”, “limitation of physical activity”, and “smoking”. At the >=2 points cut-off of the Salzburg chronic obstructive pulmonary disease screening questionnaire, sensitivity was 69.1% [95%CI: 56.6%; 79.5%], specificity 60.0% [95%CI: 54.9%; 64.9%], the positive predictive value 23.2% [95%CI: 17.7%; 29.7%] and the negative predictive value 91.8% [95%CI: 87.5%; 95.7%] to detect post bronchodilator airflow limitation. The external validation study in primary care confirmed these findings. The Salzburg chronic obstructive pulmonary disease screening questionnaire was derived from the highly standardized Burden of Obstructive Lung Disease study. This validated and easy to use questionnaire can help to increase the efficiency of chronic obstructive pulmonary disease case-finding.

Utility of Self-Administered Questionnaires for Identifying Individuals at Risk of COPD in Japan: The OCEAN (Okinawa COPD casE finding AssessmeNt) Study

“… 40–42 For example, an AUC-ROC of 0.66 was reported in a study that assessed the predictive value of the Salzburg-COPD screening questionnaire for use in a primary care setting. 42 Thus, in Japan, the CAPTURE and COPD-Q may be useful to identify symptomatic COPD, but further spirometry assessment would be needed to confirm a diagnosis. Individuals with high scores on these screening questionnaires should undergo spirometry testing, to support early diagnosis, access to preventive care, and/or appropriate COPD treatment.…”

Use of the COPD Assessment Test (CAT) to screen for COPD in dairy farmers: AIRBAg study

“…8 In contrast, the CAT questionnaire can be completed by the subject him/her self before the medical examination. Various questionnaires that screen for COPD in the general population have been developed, [9][10][11] but the advantage of the CAT questionnaire is its dual screening and monitoring function, which enables patients to be followed-up.…”

“…8 Previous studies have suggested using self-administered questionnaires to screen for COPD. [9][10][11] The COPD Assessment Test (CAT) was initially developed and validated for routinely assessing and monitoring COPD patients. 12,13 It was later used to help screen for COPD in both smokers, 14,15 and the general population.…”

Proposing the potential of utilizing the CAT score for early detection of COPD in asymptomatic patients, shifting towards a patient-centered approach: A review

“…[81] Several other diagnostic tools have been developed to detect clinically significant COPD, and various screening surveys have been launched. [82][83][84][85][86] While these instruments are often user-friendly for patients, their administration should be approached cautiously, considering their limitations. Their moderate accuracy and inability to differentiate between stages of obstruction underscore the necessity of using them in conjunction with spirometry.…”