Chest
Original ResearchCOPDQuestionnaires and Pocket Spirometers Provide an Alternative Approach for COPD Screening in the General Population
Section snippets
Population
We selected events in large cities, including health fairs, health expositions, and national conventions of older adults (such as the American Association of Retired Persons), and we also focused on selected pharmacies. Brochures about lung health were offered, but no specific information about pharmacotherapy was provided. To maintain confidentiality, no contact information from participants was collected, and the names provided by participants on the informed consent forms were not entered
Results
Between June 2008 and December 2009, 5,761 people visited a testing venue (Fig 1), provided demographic data, and completed the risk assessment questionnaire. Of these, 5,638 underwent PEF screening and comprise the analysis population for the study. Participants' mean age was 54.4 years (SD = 14.3 years), and ages ranged from 18 to 93 years (84.2% were ≥ 40 years of age). A majority of participants were women (57.9%). Participants were primarily white or Hispanic/Latino (87.5%); 12.5% were
Discussion
The results reported here demonstrate that a three-stage approach to COPD screening in the general population is both feasible and useful and avoids the need to conduct diagnostic-quality spirometry on all individuals at risk. The staged approach we used consisted of a questionnaire-based screening test, followed by a pocket spirometry assessment, followed by diagnostic spirometry. The cutoff used for our questionnaire screen (two or more risk factors) identified 84.8% of those who had PEF <
Conclusions
A pocket spirometer costs < $100. Diagnostic-quality office spirometers typically cost > $1,000. Measuring PEF requires much less training than do FVC maneuvers and can be performed rapidly by physician office staff. Using a pocket spirometer in a screening program can reduce the number of diagnostic spirometry tests required. A step-wise approach to detect undiagnosed people with clinically significant airflow obstruction can reduce costs and increase accuracy. We believe that the increased
Acknowledgments
Author contributions: Mr Nelson had full access to the data and takes responsibility for the integrity and accuracy of the data.
Mr Nelson: contributed to the study concept and design, acquisition of data, preparation and critical revision of the manuscript, and final approval of the version to be published.
Dr LaVange: contributed to the study concept and design, statistical analysis, preparation and critical revision of the manuscript, and final approval of the version to be published.
Dr Nie:
References (41)
- et al.
International variation in the prevalence of COPD (the BOLD Study): a population-based prevalence study
Lancet
(2007) - et al.
A randomized controlled trial on office spirometry in asthma and COPD in standard general practice: data from spirometry in Asthma and COPD: a comparative evaluation Italian study
Chest
(2006) - et al.
Scoring system and clinical application of COPD diagnostic questionnaires
Chest
(2006) - et al.
FEV1/FEV6 and FEV6 as an alternative for FEV1/FVC and FVC in the spirometric detection of airway obstruction and restriction
Chest
(2005) - et al.
COPD case finding by spirometry in high-risk customers of urban community pharmacies: a pilot study
Respir Med
(2009) - et al.
Spirometry and smoking cessation advice in general practice: a randomised clinical trial
Respir Med
(2006) - et al.
Spirometry utilization for COPD: how do we measure up?
Chest
(2007) - et al.
Early detection of COPD in a high-risk population using spirometric screening
Chest
(2001) - et al.
Peak expiratory flow is not a quality indicator for spirometry: peak expiratory flow variability and FEV1 are poorly correlated in an elderly population
Chest
(2007) Strategies in preserving lung health and preventing COPD and associated diseases
Chest
(1998)
Prevalence, severity and underdiagnosis of COPD in the primary care setting
Thorax
Quality of spirometry in primary care for case finding of airway obstruction in smokers
Respiration
Screening for chronic obstructive pulmonary disease using spirometry: US Preventive Services Task Force recommendation statement
Ann Intern Med
Screening for chronic obstructive pulmonary disease using spirometry: summary of the evidence for the U.S. Preventive Services Task Force
Ann Intern Med
Diagnosis and management of stable chronic obstructive pulmonary disease: a clinical practice guideline from the American College of Physicians
Ann Intern Med
Detecting patients at a high risk of developing chronic obstructive pulmonary disease in general practice: cross sectional case finding study
BMJ
Development and initial validation of a self-scored COPD Population Screener Questionnaire (COPD-PS)
COPD
Development of the Lung Function Questionnaire (LFQ) to identify airflow obstruction
Int J Chron Obstruct Pulmon Dis
External validation of a COPD diagnostic questionnaire
Eur Respir J
Can a normal peak expiratory flow exclude severe chronic obstructive pulmonary disease?
Int J Tuberc Lung Dis
Cited by (41)
Screening for impaired pulmonary function using peak expiratory flow: Performance of different interpretation strategies
2023, Respiratory Medicine and ResearchDiTA: a database of diagnostic test accuracy studies for physiotherapists
2019, Journal of PhysiotherapyMeeting the challenge of COPD care delivery in the USA: A multiprovider perspective
2016, The Lancet Respiratory MedicineCitation Excerpt :Should we continue to consider spirometry as the best tool for diagnosis? Evidence supports the role of a peak flow meter in screening and ongoing monitoring,435,436 but the use of this instrument has not been widely adopted, partly because specialists have pointed out the superior accuracy of spirometry. However, the accuracy required of such a test depends on the intended use.
Airflow obstruction case finding in community-pharmacies: A novel strategy to reduce COPD underdiagnosis
2015, Respiratory MedicineCitation Excerpt :Nonetheless, these results highlight the value of using LLN in young subjects and the need of a standardized airflow limitation definition across different guidelines Finally, our strategy involved the use of higher trained than average pharmacists, ICT support, two questionnaires and quality-controlled forced spirometry. It can be argued it is too cumbersome for many CP, so simpler screening strategies, perhaps using questionnaires and peak-expiratory flow measurements, deserve investigation [42,43]. Finally, as discussed previously, low feed-back from PC is another limitation.
Comparison of the Diagnostic Performance of Five Clinical Questionnaires for Chronic Obstructive Pulmonary Disease
2023, Canadian Respiratory JournalAwareness of COPD and Its Risk Factors Among the Adult Population of the Aseer Region, Saudi Arabia
2023, International Journal of COPD
Funding/Support: The COPD Foundation provided funding for the performance of the study.
Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.