Questionnaires and Pocket Spirometers Provide an Alternative Approach for COPD Screening in the General Population

Nelson, Shakira M.; LaVange, Lisa M.; Nie, Yonghong; Walsh, John; Enright, Paul; Martínez, Fernando J.; Mannino, David M.; Thomashow, Byron

doi:10.1378/chest.11-1474

Cited by 46 publications

(39 citation statements)

References 36 publications

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“…As a consequence, the predictive value and sensitivity of the PEF-based algorithms developed here might be better than might be expected if using ordinary peak flow meters in clinic settings or as a part of general community-based screening programmes [32,33]. However, a recent study found results similar to ours in health screening settings other than medical offices [34]. Additionally, our economic analysis considered only one set of costing assumptions and assumed these held in a uniform manner across the countries and settings undertaking the screening.…”

Section: Discussionsupporting

confidence: 53%

Case-finding options for COPD: results from the Burden of Obstructive Lung Disease Study

et al. 2012

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This study aimed to compare strategies for chronic obstructive pulmonary disease (COPD) case finding using data from the Burden of Obstructive Lung Disease study.Population-based samples of adults aged o40 yrs (n59,390) from 14 countries completed a questionnaire and spirometry. We compared the screening efficiency of differently staged algorithms that used questionnaire data and/or peak expiratory flow (PEF) data to identify persons at risk for COPD and, hence, needing confirmatory spirometry. Separate algorithms were fitted for moderate/severe COPD and for severe COPD. We estimated the cost of each algorithm in 1,000 people.For moderate/severe COPD, use of questionnaire data alone permitted high sensitivity (97%) but required confirmatory spirometry in 80% of participants. Use of PEF necessitated confirmatory spirometry in only 19-22% of subjects, with 83-84% sensitivity. For severe COPD, use of PEF achieved 91-93% sensitivity, requiring confirmatory spirometry in ,9% of participants. Cost analysis suggested that a staged screening algorithm using only PEF initially, followed by confirmatory spirometry as needed, was the most cost-effective case-finding strategy.Our results support the use of PEF as a simple, cost-effective initial screening tool for conducting COPD case-finding in adults aged o40 yrs. These findings should be validated in realworld settings such as the primary care environment.

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Section: Discussionsupporting

confidence: 53%

Case-finding options for COPD: results from the Burden of Obstructive Lung Disease Study

et al. 2012

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“…Peak flow is less studied with regards to COPD screening, but a standardized method was used to determine which results were abnormal based on validated methods from previous studies. 44,47 No CT imaging or diffusing capacity measurement was completed as part of this study due to cost constraints, and therefore it remains unclear whether abnormal spirometry results could represent emphysematous or other structural changes in the lung for which patient infected with HIV are at higher risk based on previous studies. 11,58 As shown in this study, COPD and other obstructive lung diseases remain underdiagnosed in HIV infected individuals.…”

Section: Discussionmentioning

confidence: 99%

“…Peak flow was deemed abnormal if the greatest value was less than 70% of predicted based on height, age, and race. 44,47 The questionnaire was abnormal if the score was 5 or higher. 45 Initially, those with abnormal peak flow and questionnaire went on to complete spirometry testing.…”

Section: Testing Proceduresmentioning

confidence: 99%

“…41 A combination of medical history/risk for COPD in combination with peak flow has successfully been used as a screening mechanism to identify those with COPD in the general population. [42][43][44] This study aimed to explore the predictive value of a screening strategy using a brief history and peak expiratory flow measurement for the determination of pulmonary function abnormalities and the diagnosis of COPD in patients infected with HIV. We also sought to identify HIV-related factors that could influence pulmonary function.…”

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confidence: 99%

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Screening for Chronic Obstructive Pulmonary Disease (COPD) in an Urban HIV Clinic: A Pilot Study

Shirley¹,

Kaner

Glesby

2015

AIDS Patient Care and STDs

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Increased smoking and a detrimental response to tobacco smoke in the lungs of HIV/AIDS patients result in an increased risk for COPD. We aimed to determine the predictive value of a COPD screening strategy validated in the general population and to identify HIV-related factors associated with decreased lung function. Subjects at least 35 years of age at an HIV clinic in New York City completed a COPD screening questionnaire and peak flow measurement. Those with abnormal results and a random one-third of normal screens had spirometry. 235 individuals were included and 89 completed spirometry. Eleven (12%) had undiagnosed airway obstruction and 5 had COPD. A combination of a positive questionnaire and abnormal peak flow yielded a sensitivity of 20% (specificity 93%) for detection of COPD. Peak flow alone had a sensitivity of 80% (specificity 80%). Abnormal peak flow was associated with an AIDS diagnosis ( p = 0.04), lower nadir ( p = 0.001), and current CD4 counts ( p = 0.001). Nadir CD4 remained associated in multivariate analysis (p = 0.05). Decreased FEV1 ( < 80% predicted) was associated with lower CD4 count nadir ( p = 0.04) and detectable current HIV viral load ( p = 0.01) in multivariate analysis. Questionnaire and peak flow together had low sensitivity, but abnormal peak flow shows potential as a screening tool for COPD in HIV/AIDS. These data suggest that lung function may be influenced by HIV-related factors.

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“…In an attempt to make up for this deficit, the American Association for Respiratory Care has partnered with the United States COPD Foundation to test the potential of free screening for COPD at community-based health fairs and sporting events. 14 The American Thoracic Society has developed online spirometry courses and quality mentoring for primary care providers. 15 Other methods of delivering spirometry testing to adult smokers have been tried in various countries, including itinerant nurses, 16 programs that give office spirometers or pocket spirometers to every general practitioner in the country who will accept one, [17][18][19] and training pharmacists to use office spirometers in local pharmacies.…”

Section: Introductionmentioning

confidence: 99%

Should We Keep Pushing for a Spirometer in Every Doctor's Office?

Enright

2012

Respir Care

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Professional societies have encouraged primary care providers to conduct spirometry testing for the detection of chronic obstructive pulmonary disease (COPD). In spite of this effort, the success rate is unacceptably low. Simple flow-sensing spirometers have technical flaws that can cause misreadings, and they are rarely checked for accuracy. When spirometry is performed by an experienced technologist, and when payment is made on the criterion of quality, the success rate for adults and school-aged children can be as high as 90%. But testing remains a challenge for younger children and the elderly. Regular feedback for the technologist about their testing results is essential. Even with an accurate spirometer, an able patient, and a skilled technologist, the ordering physician may wrongly interpret the data. Use of spirometry in primary care will continue to be problematic unless high quality testing is tied to reimbursement. Using FEV 1 or peak flow measurements to rule out airway abnormality in the majority of patients, followed by referral for more sophisticated studies in those remaining, may be the best approach. Respiratory therapists should engage in this effort.

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Questionnaires and Pocket Spirometers Provide an Alternative Approach for COPD Screening in the General Population

Cited by 46 publications

References 36 publications

Case-finding options for COPD: results from the Burden of Obstructive Lung Disease Study

Case-finding options for COPD: results from the Burden of Obstructive Lung Disease Study

Screening for Chronic Obstructive Pulmonary Disease (COPD) in an Urban HIV Clinic: A Pilot Study

Should We Keep Pushing for a Spirometer in Every Doctor's Office?

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