Performance and Clinical Utility of Various Chronic Obstructive Pulmonary Disease Case-Finding Tools

Abstract

Background and Aim

Chronic obstructive pulmonary disease (COPD) is frequently underdiagnosed because of the unavailability of spirometers, especially in resource-limited outpatient settings. This study provides real-world evidence to identify optimal approaches for COPD case finding in outpatient settings.

Methods

This retrospective study enrolled individuals who were at risk of COPD (age ≥40 years, ≥10 pack-years, and ≥1 respiratory symptom). Eligible participants were examined using various COPD case-finding tools, namely the COPD Population Screener (COPD-PS) questionnaire, a COPD prediction (P_COPD) model, and a microspirometer, Spirobank Smart; subsequently, the participants underwent confirmatory spirometry. The definition and confirmation of COPD were based on conventional spirometry. Receiver operating characteristic curve (ROC), area under the curve (AUC), and decision curve analyses were conducted, and a clinical impact curve was constructed.

Results

In total, 385 participants took part in the study [284 without COPD (73.77%) and 101 with COPD (26.23%)]. The microspirometer exhibited a higher AUC value than did the COPD-PS questionnaire and the P_COPD model. The AUC for microspirometry was 0.908 (95% confidence interval [CI] = 0.87–0.95), that for the P_COPD model was 0.788 (95% CI = 0.74–0.84), and that for the COPD-PS questionnaire was 0.726 (95% CI = 0.67–0.78). Decision and clinical impact curve analyses revealed that a microspirometry-derived FEV1/FVC ratio of <74% had superior clinical utility to the other measurement tools.

Conclusion

The P_COPD model and COPD-PS questionnaire were useful for identifying symptomatic patients likely to have COPD, but microspirometry was more accurate and had higher clinical utility. This study provides real-world evidence to identify optimal practices for COPD case finding; such practices ensure that physicians have convenient access to up-to-date evidence when they encounter a symptomatic patient likely to have COPD.

Keywords:

• COPD
• COPD case-finding
• P_COPD model
• COPD-PS questionnaire
• microspirometry
• spirometry

Informed Consent and Patient Details

All procedures performed in present study involving human participants were in accordance with the ethical standards of the Institutional Review Board of Changhua Christian Hospital (Approval number 210709). Written informed consent was not required because of the retrospective nature of the investigation. Patient data confidentiality was maintained, and this study was conducted in accordance with the Declaration of Helsinki.

Disclosure

The authors declare no competing interests.

Additional information

Funding

The study was funded by Changhua Christian Hospital (grant no:110-CCH-MST-122).