Chest
Volume 129, Issue 6, June 2006, Pages 1531-1539
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Original Research
Scoring System and Clinical Application of COPD Diagnostic Questionnaires

https://doi.org/10.1378/chest.129.6.1531Get rights and content

Objectives

In most primary care settings, spirometric screening of all patients at risk is not practical. In prior work, we developed questionnaires to help identify COPD in two risk groups: (1) persons with a positive smoking history but no history of obstructive lung disease (case finding), and (2) patients with prior evidence of obstructive lung disease (differential diagnosis). For these questionnaires, we now present a scoring system for use in primary care.

Methods

Scores for individual questions were based on the regression coefficients from logistic regression models using a spirometry-based diagnosis of obstruction as the reference outcome. Receiver operator characteristic analysis was used to determine performance characteristics for each questionnaire. Several simplified scoring systems were developed and tested.

Results

For both scenarios, we created a scoring system with two cut points intended to place subjects within one of three zones: persons with a high likelihood of having obstruction (high predictive value of a positive test result); persons with a low likelihood of obstruction (high predictive value of a negative test result); and an intermediate zone. Using these scoring systems, we achieved sensitivities of 54 to 82%, specificities of 58 to 88%, positive predictive values of 30 to 78%, and negative predictive values of 71 to 93%.

Conclusions

These questionnaires can be used to help identify persons likely to have COPD among specific risk groups. The use of a simplified scoring system makes these tools beneficial in the primary care setting. Used in conjunction with spirometry, these tools can help improve the efficiency and accuracy of COPD diagnosis in primary care.

Section snippets

Materials and Methods

Details of the development of the questionnaires have been described elsewhere.10, 11 In brief, two study sites (Aberdeen, Scotland and Denver, CO) were chosen for the evaluation. Subjects ≥ 40 years old were randomly selected from primary care practice rosters in these sites and invited by mail to participate in the study. Eligible respondents were enrolled after providing informed consent. Respondents were eligible if they reported the following: (1) a positive smoking history (current or

Results

The ROC curves are presented for the case-finding (Fig 1) and differential diagnosis (Fig 2) questionnaires, along with selected performance characteristics (Table 3). For each ROC curve, two cut points were determined by assessing the performance characteristics of the questions to choose those points representing the optimal combination of PPV, NPV, and the distribution of subjects between cut points. This system places subjects within one of three zones, depending on their likelihood of

Discussion

Prior work10, 11 has demonstrated that questionnaires based on patient-reported information can be used to identify persons likely to have COPD among specific risk groups. This study adds a simple scoring system to make these instruments practical for use in the primary care setting. Using this scoring system, these instruments demonstrated ROC performance comparable to that of other respiratory screening questionnaires, as illustrated in Table 6. In COPD, for example, retrospective analyses

Conclusions

The questionnaires described here can be used to identify persons likely to have COPD among specific risk groups. This can be done with acceptable performance characteristics. The use of a simple scoring system makes these tools beneficial in the primary care setting. Used in conjunction with spirometry, these tools can help improve the efficiency and accuracy of COPD diagnosis in primary care. Future work should address the reliability of the instruments, validity in different populations and

Appendix

Members of the COPD Questionnaire Study Group include William Erhardt, MD, Pfizer Inc, New York, NY; Daryl Freeman, MD, University of Aberdeen, Aberdeen, Scotland; R. J. Halbert, MD, MPH, Cerner Health Insights, Beverly Hills, CA; Thomas Hausen, MD, Essen, Germany; Sharon Isonaka, MD, MS, Cerner Health Insights, Beverly Hills, CA; Elizabeth F. Juniper, MSc, McMaster University, Hamilton, ON, Canada; Claus Justus, DVM, Boehringer Ingelheim International GmbH, Ingelheim, Germany; Mark L. Levy,

ACKNOWLEDGMENT

The authors thank the subjects who participated in the study; the staff who collected the data; study coordinators Jan Caldow in Aberdeen and Melanie Gleason in Denver; Dr. John L. Adams, who provided statistical advice; and Dr. Michael Levine, who served as a spirometry reviewer.

References (20)

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Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/misc/reprints.shtml)

for the COPD Questionnaire Study Group

Dr. Price has received honoraria for speaking at sponsored meetings and serving on advisory panels for the following companies marketing COPD products: AstraZeneca, Boehringer Ingelheim, GlaxoSmithKline, Novartis, and Pfizer. He or his research team have received funding for research projects from the same companies. Dr. Tinkelman is an employee of National Jewish Medical and Research Center, which received funding from Boehringer Ingelheim to participate in this study. At the time this work was performed, Drs. Nordyke, Isonaka and Halbert were employees of Cerner Health Insights, which provides consulting services to the pharmaceutical industry, including the sponsors of this project.

Portions of this article were presented at meetings of the International Primary Care Respiratory Group (International Congress: Melbourne, Australia; February 19 to 22, 2004) and the Asian Pacific Society of Respirology (Ninth Congress: Hong Kong, December 10 to 13, 2004).

This project was funded by Boehringer Ingelheim International GmbH and Pfizer Inc.

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