Symptom-Based Questionnaire for Identifying COPD in Smokers

Abstract

Background: Symptom-based questionnaires may enhance chronic obstructive pulmonary disease (COPD) screening in primary care. Objectives: We prospectively tested questions to help identify COPD among smokers without prior history of lung disease. Methods: Subjects were recruited via random mailing to primary care practices in Aberdeen, UK, and Denver, Colo., USA. Current and former smokers aged 40 or older with no prior respiratory diagnosis and no respiratory medications in the past year were enrolled. Participants answered questions covering demographics and symptoms and then underwent spirometry with reversibility testing. A study diagnosis of COPD was defined as fixed airway obstruction as measured by postbronchodilator FEV₁/FVC <0.70. We examined the ability of individual questions in a multivariate framework to correctly discriminate between persons with and without COPD. Results: 818 subjects completed all investigations and proceeded to analysis. The list of 54 questions yielded 52 items for analysis, which was reduced to 17 items for entry into multivariate regression. Eight items had significant relationships with the study diagnosis of COPD, including age, pack-years, body mass index, weather-affected cough, phlegm without a cold, morning phlegm, wheeze frequency, and history of any allergies. Individual items yielded odds ratios ranging from 0.23 to 12. This questionnaire demonstrated a sensitivity of 80.4 and specificity of 72.0. Conclusions: A simple patient self-administered questionnaire can be used to identify patients with a high likelihood of having COPD, for whom spirometric testing is particularly important. Implementation of this questionnaire could enhance the efficiency and diagnostic accuracy of current screening efforts.

The International Primary Care Respiratory Group (IPCRG) Research Needs Statement 2010

“…35 Validated questionnaires have been developed to support the diagnosis of COPD. [159][160][161] Practical experience with these tools is limited and it is not yet clear how such questionnaires can best be used in clinical practice -e.g. to identify patients for spirometry, or to replace spirometry in low income countries where spirometry is not available.…”

“…159,162 International guidelines advise spirometry in all people with respiratory symptoms and/or smoking exposure. 143,163,164 Such initiatives are likely to be the responsibility of primary care services, but the clinical and cost effectiveness of different strategies (screening or case-finding, questionnaire or spirometry testing, based in primary care or linked with occupational health, health insurance screening) have yet to be established.…”

International Primary Care Respiratory Group (IPCRG) Guidelines: Integrating diagnostic guidelines for managing chronic respiratory diseases in primary care

“…Using prospective methodology, this set of questions has been validated and shown to support diagnosis in a primary care setting [44].…”

Validation of the COPD Diagnostic Questionnaire in an Australian general practice cohort: a cross-sectional study

“…5 Several studies in different populations around the world have looked at devising a questionnaire for the diagnosis of COPD or, alternatively, using a questionnaire as a filter to select people at risk (such as tobacco smokers, passive tobacco exposure, and increasing age) for further investigation by spirometry. [9][10][11][12][13][14] The COPD Diagnostic Questionnaire (CDQ) is an eight-item tool designed by the COPD Questionnaire Study Group from a cross-sectional study of primary care patients aged >40 years from the UK and USA with a history of smoking but no prior respiratory diagnosis (see Appendix 1, available online at www.thepcrj.org). 11,12 It was developed to improve the efficiency and accuracy of COPD diagnosis in primary care by removing the need for spirometry in low-risk patients.…”

“…[9][10][11][12][13][14] The COPD Diagnostic Questionnaire (CDQ) is an eight-item tool designed by the COPD Questionnaire Study Group from a cross-sectional study of primary care patients aged >40 years from the UK and USA with a history of smoking but no prior respiratory diagnosis (see Appendix 1, available online at www.thepcrj.org). 11,12 It was developed to improve the efficiency and accuracy of COPD diagnosis in primary care by removing the need for spirometry in low-risk patients. 11,12 It is also known as the International Primary Care Airways Guidelines (IPAG) questionnaire.…”