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

Abstract

Purpose

A considerable proportion of patients with chronic obstructive pulmonary disease (COPD) remain undiagnosed and untreated even though they may have a burden of respiratory symptoms that impact quality of life. The OCEAN study assessed the ability of screening questionnaires to identify individuals with, or at risk of, COPD by comparing questionnaire outcomes with spirometric measures of lung function.

Methods

This observational study included participants ≥40 years of age presenting for their annual health examination at a single medical center in Okinawa, Japan. Participants completed COPD screening questionnaires (CAPTURE and COPD-Q), the Chronic Airways Assessment Test (CAAT), and general demographic and health-related questionnaires. The performance characteristics of CAPTURE and COPD-Q were compared with spirometry-based airflow limitation by calculating the area under the receiver operating characteristic (ROC-AUC) curve.

Results

A total of 2518 participants were included in the study; 79% of whom were <60 years of age (mean 52.0 years). A total of 52 (2.1%) participants had airflow limitation defined as forced expiratory volume in 1 second (FEV₁)/forced vital capacity (FVC) <0.7, and 420 (16.7%) participants were classified as Preserved Ratio Impaired Spirometry (PRISm). Among participants with PRISm, 75 (17.9%) had a CAAT total score ≥10. Airflow limitation and PRISm were more prevalent in current smokers versus past smokers. For the CAPTURE questionnaire, ROC-AUC for screening airflow limitation, PRISm, and PRISm with a CAAT total score ≥10 were 0.59, 0.55, and 0.69, respectively; for COPD-Q, these three clinical features were 0.67, 0.58 and 0.68, respectively.

Conclusion

This study demonstrated that CAPTURE and COPD-Q appear to be effective screening tools for identifying symptomatic individuals with undiagnosed, or at risk of developing COPD in adults ≥40 years of age in Okinawa. Furthermore, early diagnosis and management of PRISm is important to improve future outcomes and the societal burden of disease.

Keywords:

• COPD
• CAAT
• COPD-Q
• Japan
• PRISm
• CAPTURE

Abbreviations

AUC, area under the curve; BMI, body mass index; CAAT, chronic airways assessment test; CAPTURE, COPD Assessment in Primary Care to Identify Undiagnosed Respiratory Disease and Exacerbation Risk; CAT, COPD Assessment Test; COPD, chronic obstructive pulmonary disease; COPD-Q, COPD screening questionnaire; FEV₁, forced expiratory volume in 1 second; FVC, forced vital capacity; OCEAN, Okinawa COPD casE finding AssessmeNt; PRISm, preserved ratio impaired spirometry; PROMIS, Patient-Reported Outcomes Measurement Information System; ROC, receiver operating characteristic; SD, standard deviation.

Data Sharing Statement

Anonymized individual participant data and study documents can be requested for further research from www.clinicalstudydatarequest.com. The corresponding author had full access to all the data and the final responsibility to submit for publication.

Acknowledgments

Editorial support in the form of preparation of the first draft based on input from all authors, and collation and incorporation of author feedback to develop subsequent drafts, was provided by Fiona Woodward, PhD, CMPP, and Alexandra Berry at Fishawack Indicia Ltd., UK, part of Fishawack Health, and was funded by GlaxoSmithKline (GSK). Parts of this paper were presented at the American Thoracic Society 2020 Virtual conference as a poster presentation with interim findings. The poster’s abstract was published in the American Journal of Respiratory and Critical Care Medicine 2020:201: A5031: https://doi.org/10.1164/ajrccm-conference.2020.201.1_MeetingAbstracts.A5031.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

Kentaro Tamaki, Eishin Sakihara, Hiroaki Miyata, and Norimichi Hirahara belong to the association/institution that received funding for this study from GSK. Takeo Ishii, Shoko Akiyama, Toshihiko Kaise, Masayuki Katsumata and Ryosuke Tawara are employees of GSK and hold shares in GSK. Mei Haruya, Oksana Kirichek and Edgar P. Simard are former employees of GSK. Bruce E. Miller and Ruth Tal-Singer are former employees of GSK and hold shares in GSK. Ruth Tal-Singer reports personal fees from Ena Respiratory, Immunomet, Vocalis Health, and Teva. The authors report no other conflicts of interest in this work.

Additional information

Funding

This study was funded by GSK (Study HO-18-19229/209243). The funders of the study had a role in study design, data analysis, data interpretation, and writing of the report.