RT Journal Article
SR Electronic
T1 Risk stratification for COPD diagnosis in a primary care setting
JF European Respiratory Journal
JO Eur Respir J
FD European Respiratory Society
SP P3027
VO 44
IS Suppl 58
A1 Rosa Malo de Molina
A1 Pedro J. Marcos
A1 Ricard Casamor
YR 2014
UL http://erj.ersjournals.com/content/44/Suppl_58/P3027.abstract
AB AIM: To study predictive factors for COPD in patients arriving to primary care clinics for any reasonMETHODS: Observational, cross-sectional, multicenter study at a primary care setting in Spain. Subjects over 40 were recruited with the following criteria: any respiratory symptom, history of smoking (> 10 pack-years) and no previous COPD diagnosis/treatment. In a single visit, consenting patients reported smoking history, symptoms, and comorbidities. Spirometry + reversibility test was conducted (ATS standards) and QoL questionnaire (CAT) was completed. By multivariate logistic regression techniques using receiver operating characteristic (ROC) curves, the best combination of variables to discriminate COPD was identified (defined as higher area under the ROC curve)RESULTS: At 368 clinics, 2758 subjects were selected and 1725 entered the analyses. After spirometry 793 (46%) were diagnosed of COPD. Best questions to discriminate between subjects with/without COPD were: lower respiratory tract infections during previous year, dyspnea, chronic cough and comorbidities. This combination of 4 items identified COPD patients with sensitivity 54.2% and specificity 65.2%, while 41.58% patients were incorrectly classified as COPD. This set of 4 items performs slightly better (ROC 0.63) than a second model using only 3 items (history of lower tract infections, dyspnea and cough) with a ROC of 0.61, Sens 48.4%, Spec 66.04%CONCLUSION: In a high-risk population of mid-age smokers (> 10 pack-years) and at least one respiratory symptom, current and past medical history is probably not useful to identify patients with increased risk of airflow limitation. Spirometry remains the only way to accurately diagnose COPD.