Abstract
We aimed at enhancing COPD diagnosis through two case finding approaches: during COPD Day and developing a primary care COPD detecting program. We targeted ever smokers, 40 years and older.
Objectives: To explore the yield of active and opportunistic case finding strategies.
Methods: Active case-finding approach was undertaken during COPD Day campaigns and a primary care (PC) COPD detection program was developed (opportunistic approach) for individuals willing to submit to lung function and fulfill a short symptom questionnaire. COPD diagnosis by FEV1/FVC<0.7 and severity through FEV1%.We calculated predictive positive value (PPV), sensitivity, specificity for symptoms and yield of case-finding.
Results: 1033 subjects from COPD campaigns compared to 300 at PC: men 50.7 vs 36.7% mean age 59.7± 10.8 vs 58.9 ± 9.7 years; airflow limitation 323 (31%) vs 104 (34.7%); stages: I:39%,II:45.2%,III-IV:15.8% vs I: 41.3%, II: 56.7%, III-IV: 1.9%; cough 404 (39.1%) vs 254 (84.7%).PPV 36 vs 36%, sensitivity 45 vs 88%, specificity 63 vs 17%, ROC AUC 0.54[95%CI=0.50-0.57] vs 0.52[95%CI=0.46-0.59] pleghm 408 (39.5%) vs 182 (60.7%).PPV 38 vs 39%, sensitivity 48 vs 69%, specificity 64 vs 44%, ROC AUC 0.56[95%CI=0.52-0.60] vs 0.56[95%CI=0.49-0.63], dyspnea 505 (49 %) vs 240 (80 %). PPV 38 vs 35 %, sensitivity 57 vs 81%, specificity 58 vs 20%, ROC AUC 0.57 [95%CI=0.53-0.61] vs 0.50[95%CI=0.43-0.57]; one positive spirometry out of completed 3.2 vs 2.88.
Conclusions: Irrespective of the presence of symptoms, in ever smokers 40 years and older, both active and opportunistic case finding for COPD are valuable strategies with similar yield: three spirometries are needed to diagnose one COPD patient; in 60% FEV1 ≤ 80%.
- Copyright ©ERS 2015