Development of a self-scored persistent airflow obstruction screening questionnaire in a general Japanese population: the Hisayama study

Abstract

Background

The use of a simple screening questionnaire to detect persistent airflow obstruction (AO) in COPD may facilitate the early, accurate diagnosis of COPD in general practice settings.

Objective

This study developed an original persistent AO questionnaire for screening individuals with COPD in a general Japanese population.

Methods

A working group was established to generate initial draft questionnaire items about COPD. Eligible subjects aged 40 and older living in Japan were solicited to participate in a health checkup from 2014 to 2015. In study I, 2,338 subjects who fully completed the initial draft questionnaire and who had valid spirometry measurements were statistically analyzed to determine the final questionnaire items as a COPD screening questionnaire (COPD-Q). Persistent AO was defined as a post-bronchodilator FEV₁/FVC <0.70. In study II, the working group analyzed the weighted scores for individual items and established a cutoff point for the COPD-Q based on the data of 2,066 subjects in the Hisayama study. Receiver operating characteristic (ROC) curves were used to examine the ability of the COPD-Q to discriminate between subjects with and without AO.

Results

The five-item COPD-Q was established based on 19 initial draft items in study I and the weighted scores of individual items. The overall area under the ROC curve for the COPD-Q was 0.796 (95% confidence interval, 0.707–0.788). A cutoff of 4 points resulted in a sensitivity of 71.0% and a specificity of 70.1%. The positive predictive value was 10.8%, and the negative predictive value was 97.9%. The crude odds ratio of the COPD-Q for AO was 5.8.

Conclusion

The five-item COPD-Q is a useful questionnaire for diagnosing persistent AO in a general Japanese population and is expected to be an effective first-stage screening tool for detecting COPD.

Keywords:

• COPD screening
• questionnaires
• Japanese population
• bronchodilator
• pulmonary function tests
• airflow obstruction

Supplementary materials

Figure S1 Japanese version of the COPD-Q.

Abbreviation: COPD-Q, COPD screening questionnaire.

Table S1 The initial draft questionnaire

Acknowledgments

This research was supported by a Grant-in Aid from Japan Society for the Promotion of Science (JSPS) and from Japan Agency for Medical Research and development, AMED. The authors thank Satoko Shimoota, Daichi Hamasaki, Akihiro Kakoi, Tadahiko Amiya, Manami Iwamoto, and Machiko Higo for their assistance in data collection. The Hisayama Pulmonary Physiology Study Group included Satoru Fukuyama, Koichiro Matsumoto, Takako Nakano, Atsushi Moriwaki, Yuko Matsunaga, Keiko Kan-o, Naotaka Noda, Yukari Tajiri-Asai, Hiroko Hirai, Yumiko Ishii, Saaka Hamano, Ken Tonai, Nanae Seki, Ayako Hashizume, Makiko Kogo, Misae Awane, and Yoichi Nakanishi from Research Institute for Diseases of the Chest, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Go Tsukuya, Takuya Samukawa, and Hiromasa Inoue from Department of Pulmonary Medicine, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan; Makoto Yoshida, Masashi Komori, and Yasuko Kaneko from Section of Pulmonary Medicine, Fukuoka National Hospital, Fukuoka, Japan; Shohei Takata and Mikiko Matsuo-Matsumura from Division of Respiratory Medicine, National Fukuoka-Higashi Medical Center, Fukuoka, Japan; Hiroshi Koto from Department of Respiratory Medicine, Kyushu Central Hospital, Fukuoka, Japan.

Author contributions

All authors contributed toward data acquisition, data analysis, and drafting and critically revising the paper and agree to be accountable for all aspects of the work.

Disclosure

The authors report no conflicts of interest in this work.