Abstract
Chronic obstructive pulmonary disease prevalence rates are still high. However, the majority of subjects are not diagnosed. Strategies have to be implemented to overcome the problem of under-diagnosis. Questionnaires could be used to pre-select subjects for spirometry and thereby help reducing under-diagnosis. We report a brief, simple, self-administrable and validated chronic obstructive pulmonary disease questionnaire to increase the pre-test probability for chronic obstructive pulmonary disease diagnosis in subjects undergoing confirmatory spirometry. In 2005, we completed the Austrian Burden of Obstructive Lung Disease-study in 1258 subjects aged >40 years. Post-bronchodilator spirometry was performed, and non-reversible airflow limitation defined by FEV1/FVC ratio below the lower limit of normal. Questions from the Salzburg chronic obstructive pulmonary disease screening-questionnaire were selected using a logistic regression model, and risk scores were based on regression-coefficients. A training sub-sample (n = 800) was used to create the score, and a test sub-sample (n = 458) was used to test it. In 2008, an external validation study was done, using the same protocol in 775 patients from primary care. The Salzburg chronic obstructive pulmonary disease screening questionnaire was composed of items related to “breathing problems”, “wheeze”, “cough”, “limitation of physical activity”, and “smoking”. At the >=2 points cut-off of the Salzburg chronic obstructive pulmonary disease screening questionnaire, sensitivity was 69.1% [95%CI: 56.6%; 79.5%], specificity 60.0% [95%CI: 54.9%; 64.9%], the positive predictive value 23.2% [95%CI: 17.7%; 29.7%] and the negative predictive value 91.8% [95%CI: 87.5%; 95.7%] to detect post bronchodilator airflow limitation. The external validation study in primary care confirmed these findings. The Salzburg chronic obstructive pulmonary disease screening questionnaire was derived from the highly standardized Burden of Obstructive Lung Disease study. This validated and easy to use questionnaire can help to increase the efficiency of chronic obstructive pulmonary disease case-finding.
Highlights
Chronic obstructive pulmonary disease (COPD) is the third leading cause of death globally in 2010.1 available morbidity data greatly underestimate the burden of COPD.[2,3,4] Due to the insidious nature of COPD, the disease usually progresses unnoticed in many subjects and causes irreversible lung damage
1258 subjects from the Salzburg Burden of Obstructive Lung Disease study (BOLD) study with complete spirometry and questionnaire data were included
Sex, education, respiratory symptoms, smoking and perception of health were significantly associated with non-reversible post bronchodilator (PBD) FEV1/FVC < lower limit of normal (LLN)
Summary
Chronic obstructive pulmonary disease (COPD) is the third leading cause of death globally in 2010.1 available morbidity data greatly underestimate the burden of COPD.[2,3,4] Due to the insidious nature of COPD, the disease usually progresses unnoticed in many subjects and causes irreversible lung damage. The results of the international Burden of Obstructive Lung Disease study (BOLD) have shown that the majority of subjects with post bronchodilator (PBD) FEV1/FVC< lower limit of normal (LLN) are not diagnosed.[3,4,5] many of those undiagnosed have mild disease, they are the group with the greatest potential health gain from timely intervention and treatment. Knowledge about one’s abnormal lung function has been shown to be positively associated with successful smoking cessation in some studies[10,11] while others have not corroborated this finding.[12,13] Early pharmacological treatment of mild to moderate
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