TY - JOUR
T1 - Case-finding options for COPD
T2 - Results from the burden of obstructive lung disease study
AU - Jithoo, Anamika
AU - Enright, Paul L.
AU - Burney, Peter
AU - Buist, A. Sonia
AU - Bateman, Eric D.
AU - Tan, Wan C.
AU - Studnicka, Michael
AU - Mejza, Filip
AU - Gillespie, Suzanne
AU - Vollmer, William M.
PY - 2013/3/1
Y1 - 2013/3/1
N2 - 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 agedo40 yrs. These findings should be validated in realworld settings such as the primary care environment.
AB - 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 agedo40 yrs. These findings should be validated in realworld settings such as the primary care environment.
KW - Adult
KW - Chronic obstructive pulmonary disease
KW - Epidemiology
KW - Peak expiratory flow
KW - Questionnaire
KW - Screening
UR - http://www.scopus.com/inward/record.url?scp=84875266353&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84875266353&partnerID=8YFLogxK
U2 - 10.1183/09031936.00132011
DO - 10.1183/09031936.00132011
M3 - Article
C2 - 22743668
AN - SCOPUS:84875266353
SN - 0903-1936
VL - 41
SP - 548
EP - 555
JO - European Respiratory Journal
JF - European Respiratory Journal
IS - 3
ER -