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Accuracy of different screening strategies for undiagnosed COPD in primary care in China: a Breathe Well study

Zihan Pan, Andrew Dickens, Chunhua Chi, Xia Kong, Alexandra Enocson, Brendan G Cooper, Peymané Adab, Kar Keung Cheng, Alice Sitch, Sue Jowett, Rachel E Jordan
European Respiratory Journal 2021 58: PA3627; DOI: 10.1183/13993003.congress-2021.PA3627
Zihan Pan
1Peking University Third Hospital, Beijing, China
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  • For correspondence: panzihan@yeah.net
Andrew Dickens
2University of Birmingham, Birmingham, United Kingdom
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Chunhua Chi
3Peking University First Hospital, Beijing, China
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Xia Kong
3Peking University First Hospital, Beijing, China
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Alexandra Enocson
2University of Birmingham, Birmingham, United Kingdom
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Brendan G Cooper
2University of Birmingham, Birmingham, United Kingdom
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Peymané Adab
2University of Birmingham, Birmingham, United Kingdom
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Kar Keung Cheng
2University of Birmingham, Birmingham, United Kingdom
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Alice Sitch
2University of Birmingham, Birmingham, United Kingdom
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Sue Jowett
2University of Birmingham, Birmingham, United Kingdom
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Rachel E Jordan
2University of Birmingham, Birmingham, United Kingdom
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Abstract

Background: Undiagnosed COPD is a major problem in China but the optimal screening strategy to identify new cases is unclear.

Aims and objectives: To evaluate the accuracy and cost-effectiveness of COPD screening tests and strategies amongst primary care patients in China

Methods: Test accuracy study in four municipalities. Participants completed six index tests (CDQ, CAPTURE, Chinese Symptom-based questionnaire [C-SBQ], COPD-SQ, microspirometry [COPD-6], peak flow [USPE]) and the reference test (post-bronchodilator ndd Easy On-PC). Cases were those with FEV1/FVC below the lower limit of normal (LLN) on the reference test. Performance of individual screening tests and strategies was analysed, with cost-effectiveness analyses providing cost per additional true case detected.

Results: 2445 participants (mean age 59.8 years, 39.1% [n=956] male) completed the study, 68.9% (n=1684) were never-smokers and 9.7% (n=237) had an existing COPD diagnosis. 13.6% (n=333) had spirometry-confirmed airflow obstruction. Airflow measurement devices (sensitivities 64.9% and 67.3%, specificities 89.7% and 82.6% for microspirometry and peak flow respectively) generally performed better than questionnaires, the most accurate of which was C-SBQ (sensitivity 63.1%, specificity 74.2%). The combination of C-SBQ and microspirometry used in parallel, maximised sensitivity (81.4%) and had specificity of 68%, with an incremental cost-effectiveness ratio of £64.20 (CNY385) per additional case detected compared with peak flow.

Conclusions: Simple screening tests to identify undiagnosed COPD within the primary care setting in China are possible, and a combination of C-SBQ and microspirometry is the most sensitive.

  • Diagnosis
  • COPD - diagnosis

Footnotes

Cite this article as: European Respiratory Journal 2021; 58: Suppl. 65, PA3627.

This abstract was presented at the 2021 ERS International Congress, in session “Prediction of exacerbations in patients with COPD”.

This is an ERS International Congress abstract. No full-text version is available. Further material to accompany this abstract may be available at www.ers-education.org (ERS member access only).

  • Copyright ©the authors 2021
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Accuracy of different screening strategies for undiagnosed COPD in primary care in China: a Breathe Well study
Zihan Pan, Andrew Dickens, Chunhua Chi, Xia Kong, Alexandra Enocson, Brendan G Cooper, Peymané Adab, Kar Keung Cheng, Alice Sitch, Sue Jowett, Rachel E Jordan
European Respiratory Journal Sep 2021, 58 (suppl 65) PA3627; DOI: 10.1183/13993003.congress-2021.PA3627

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Accuracy of different screening strategies for undiagnosed COPD in primary care in China: a Breathe Well study
Zihan Pan, Andrew Dickens, Chunhua Chi, Xia Kong, Alexandra Enocson, Brendan G Cooper, Peymané Adab, Kar Keung Cheng, Alice Sitch, Sue Jowett, Rachel E Jordan
European Respiratory Journal Sep 2021, 58 (suppl 65) PA3627; DOI: 10.1183/13993003.congress-2021.PA3627
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