Screening For Pulmonary Disease Research Articles

Validation of a Chronic Obstructive Pulmonary Disease screening questionnaire for population surveys

The Confronting Chronic Obstructive Pulmonary Disease (COPD) Survey in North America and Europe conducted during 1999–2000 aimed to identify international differences in the clinical management of COPD and the patients’ perspectives on their disease. Our aim was to validate the screening questionnaire used in this study in a sample of patients presenting at a respiratory clinic. Interviews were conducted at an outpatient clinic of the London Chest Hospital. Of the 136 patients contacted, 25 refused or were not able to participate. Questionnaire data were validated by comparison with medical records and spirometry on 104 patients. Overall, the questionnaire correctly identified 86.5% of patients with a diagnosis of COPD with a chance-corrected agreement ( κ=0.66, se 0.098), which indicates good agreement between the questionnaire α and the medical records. The questionnaire had a high sensitivity (92.0%) and specificity (72.4%) with respect to the diagnosis of COPD. The screening questionnaire used in The Confronting COPD Survey appears to be a valid screening tool to differentiate COPD from other respiratory diseases.

Lack of usefulness of radiographic screening for pulmonary disease in asymptomatic HIV-infected adults. Pulmonary Complications of HIV Infection Study Group

To determine the use of chest radiographs in the screening of asymptomatic adults infected with the human immunodeficiency virus (HIV). A prospective, multicenter study of the pulmonary complications of HIV infection in a community-based cohort of persons with and without HIV infection. The subjects included 1065 HIV-seropositive subjects without the acquired immunodeficiency syndrome at the time of enrollment: 790 homosexual men, 226 injection drug users, and 49 women with heterosexually acquired infection. Frontal and lateral chest radiographs were performed at 3-, 6-, and 12-month intervals, CD4 lymphocyte measurements at 3- and 6-month intervals, tuberculin and mumps skin tests at 12-month intervals, and medical histories and physical examinations at 3- and 6-month intervals. Pulmonary diagnoses that occurred within 2 months following each radiograph were analyzed and correlated with the radiographic results. Evaluable screening chest radiographs (5263) were performed in HIV-seropositive subjects while they were asymptomatic; of these, 5140 (98%) were classified as normal and 123 (2%) as abnormal. A new pulmonary diagnosis was identified within 2 months following a screening radiograph in 55 subjects. Only 11 of these subjects had abnormal radiographs; the sensitivity of the radiograph was 20%. The sensitivity was similarly low at baseline, within each transmission category, and in subjects whose CD4 lymphocyte counts were less than 0.2 x 10(9)/L (200/microL). The types of pulmonary diseases that occurred were similar in the subjects with normal and abnormal screening radiographs. Screening chest radiography in asymptomatic HIV-infected adults is unwarranted because the diagnostic yield is low.

Lack of Usefulness of Radiographic Screening for Pulmonary Disease in Asymptomatic HIV-Infected Adults

To determine the use of chest radiographs in the screening of asymptomatic adults infected with the human immunodeficiency virus (HIV).A prospective, multicenter study of the pulmonary complications of HIV infection in a community-based cohort of persons with and without HIV infection. The subjects included 1065 HIV-seropositive subjects without the acquired immunodeficiency syndrome at the time of enrollment: 790 homosexual men, 226 injection drug users, and 49 women with heterosexually acquired infection. Frontal and lateral chest radiographs were performed at 3-, 6-, and 12-month intervals, CD4 lymphocyte measurements at 3- and 6-month intervals, tuberculin and mumps skin tests at 12-month intervals, and medical histories and physical examinations at 3- and 6-month intervals. Pulmonary diagnoses that occurred within 2 months following each radiograph were analyzed and correlated with the radiographic results.Evaluable screening chest radiographs (5263) were performed in HIV-seropositive subjects while they were asymptomatic; of these, 5140 (98%) were classified as normal and 123 (2%) as abnormal. A new pulmonary diagnosis was identified within 2 months following a screening radiograph in 55 subjects. Only 11 of these subjects had abnormal radiographs; the sensitivity of the radiograph was 20%. The sensitivity was similarly low at baseline, within each transmission category, and in subjects whose CD4 lymphocyte counts were less than 0.2 x 10(9)/L (200/microL). The types of pulmonary diseases that occurred were similar in the subjects with normal and abnormal screening radiographs.Screening chest radiography in asymptomatic HIV-infected adults is unwarranted because the diagnostic yield is low.

Design of a prospective study of the pulmonary complications of human immunodeficiency virus infection

Because no studies have systematically described the pulmonary complications associated with early stages of infection with the human immunodeficiency virus (HIV), the National Heart, Lung and Blood Institute and the National Institute of Allergy and Infectious Diseases jointly initiated a prospective cohort study in 1987 to describe the incidence and course of lung diseases at all stages of HIV infection. This paper describes the ongoing study and highlights some of its unusual features. Six clinical centers from different geographic areas in the U.S. began enrolling participants in 1988, and the resulting cohort comprises 1353 members. HIV seropositive participants were randomized to “intensive” (pulmonary disease screening and follow-up at 3-month intervals) or “routine” (6-month follow-up intervals with annual screening) follow-up to assess the impact of these strategies on patient outcomes. New information from this complex study will lead to a broader understanding of the pulmonary diseases associated with HIV infection and will have relevance to clinical as well as epidemiologic aspects of HIV disease.

A Community Pulmonary Disease Screening Effort: “Denver Lung Days”

A community-wide program of screening for pulmonary disease was designed to examine (1) the feasibility of performing spirometric tests of pulmonary function on a large number of subjects in a short period of time using volunteer workers, (2) the accuracy of the results of screening, (3) the reliability of the electronic spirometers used, (4) whether those advised to seek medical attention actually did so, and (5) what evaluation and therapeutic endeavors physicians carried out when consulted by these patients. Over 2,500 people underwent testing in nine centers over a period of nine hours. Of the 2,586 people, 466 individuals (18 percent) had a ratio of the forced expiratory volume in one second over the forced vital capacity (FEV1/FVC) that was less than 70 percent, and 181 persons (7 percent) had an FEV1/FVC that was less than 60 percent. On formal retesting of a random sample, all 25 persons with a screening value for FEV1/FVC that was greater than 70 percent had the same in the laboratory. All 35 subject with an FEV1/FVC that was less than 60 percent in the laboratory were identified as abnormal (FEV1/FVC less than 70 percent) by screening; however, 50 subjects, approximately 40 percent of those tested in the laboratory with a screening value for FEV1/FVC that was less man 70 percent, actually had a ratio greater than 70 percent All spirometers maintained calibration within 10 percent Of 61 subjects who first learned by this screening that they might have abnormalities of pulmonary function, 33 (54 percent) of those advised to seek medical attention did so. One-half of the symptomatic patients with abnormal spirometric data were treated with bronchodilator medication by their physicians. Although there was “overcall” of abnormality, the program was valuable in demonstrating feasibility, the reliability of the spirometer, and the subjects' concern over abnormal results. Diagnostic and therapeutic recommendations for physicians should be included in any future screening efforts. A community-wide program of screening for pulmonary disease was designed to examine (1) the feasibility of performing spirometric tests of pulmonary function on a large number of subjects in a short period of time using volunteer workers, (2) the accuracy of the results of screening, (3) the reliability of the electronic spirometers used, (4) whether those advised to seek medical attention actually did so, and (5) what evaluation and therapeutic endeavors physicians carried out when consulted by these patients. Over 2,500 people underwent testing in nine centers over a period of nine hours. Of the 2,586 people, 466 individuals (18 percent) had a ratio of the forced expiratory volume in one second over the forced vital capacity (FEV1/FVC) that was less than 70 percent, and 181 persons (7 percent) had an FEV1/FVC that was less than 60 percent. On formal retesting of a random sample, all 25 persons with a screening value for FEV1/FVC that was greater than 70 percent had the same in the laboratory. All 35 subject with an FEV1/FVC that was less than 60 percent in the laboratory were identified as abnormal (FEV1/FVC less than 70 percent) by screening; however, 50 subjects, approximately 40 percent of those tested in the laboratory with a screening value for FEV1/FVC that was less man 70 percent, actually had a ratio greater than 70 percent All spirometers maintained calibration within 10 percent Of 61 subjects who first learned by this screening that they might have abnormalities of pulmonary function, 33 (54 percent) of those advised to seek medical attention did so. One-half of the symptomatic patients with abnormal spirometric data were treated with bronchodilator medication by their physicians. Although there was “overcall” of abnormality, the program was valuable in demonstrating feasibility, the reliability of the spirometer, and the subjects' concern over abnormal results. Diagnostic and therapeutic recommendations for physicians should be included in any future screening efforts.

The Flow Volume Loop: Normal Standards and Abnormalities in Chronic Obstructive Pulmonary Disease

The flow-volume loop is a test of ventilatory function in which a graphic recording of maximal flow rates is displayed at all lung volumes during a maximal effort forced expiratory and inspiratory vital capacity maneuver. The test is easy to demonstrate, administer, and analyze. Pulmonary diseases produce characteristic flow-volume loop abnormalities. The visualization of abnormalities and calculation of instantaneous flow rates at specific lung volumes make this test useful in screening for pulmonary disease, assessing the pulmonary effect of drugs, and following progression or regression of pulmonary disease. Normal standards for loop vital capacity, volume expired or inspired to achieve peak flow rate, expiratory and inspiratory peak flow rates, flow rates at 25 percent, 50 percent, and 75 percent of the vital capacity, and prediction equations for these indices are reported. Patterns of abnormality detected in the chronic obstructive pulmonary diseases, bronchial asthma, chronic bronchitis, and pulmonary emphysema are described. Alteration of position from sitting to standing or supine for performance of the test did not significantly alter mean flow-volume loop indices.