Abstract
Background Many people with asthma and COPD remain undiagnosed. We developed and validated a new case-finding questionnaire to identify symptomatic adults with undiagnosed obstructive lung disease.
Methods Adults in the community with no prior history of physician-diagnosed lung disease who self-reported respiratory symptoms were contacted via random-digit dialling. Pre- and post-bronchodilator spirometry was used to confirm asthma or COPD. Predictive questions were selected using multinomial logistic regression with backward elimination. Questionnaire performance was assessed using sensitivity, predictive values and area under the receiver operating characteristic curve (AUC). The questionnaire was assessed for test–retest reliability, acceptability and readability. External validation was prospectively conducted in an independent sample and predictive performance re-evaluated.
Results A 13-item Undiagnosed COPD and Asthma Population Questionnaire (UCAP-Q) case-finding questionnaire to predict undiagnosed asthma or COPD was developed. The most appropriate risk cut-off was determined to be 6% for either disease. Applied to the derivation sample (n=1615), the questionnaire yielded a sensitivity of 92% for asthma and 97% for COPD; specificity of 17%; and an AUC of 0.69 (95% CI 0.64–0.74) for asthma and 0.82 (95% CI 0.78–0.86) for COPD. Prospective validation using an independent sample (n=471) showed sensitivities of 93% and 92% for asthma and COPD, respectively; specificity of 19%; with AUCs of 0.70 (95% CI 0.62–0.79) for asthma and 0.81 (95% CI 0.74–0.87) for COPD. AUCs for UCAP-Q were higher compared to AUCs for currently recommended case-finding questionnaires for asthma or COPD.
Conclusions The UCAP-Q demonstrated high sensitivities and AUCs for identifying undiagnosed asthma or COPD. A web-based calculator allows for easy calculation of risk probabilities for each disease.
Abstract
This study describes the development and prospective validation of a novel case-finding questionnaire to identify adults with undiagnosed asthma or COPD. This marks the first study to incorporate both diseases into a single case-finding instrument. https://bit.ly/3t9f0k3
Footnotes
This article has an editorial commentary: https://doi.org/10.1183/13993003.00679-2022
Conception and design: S.D. Aaron and G.A. Whitmore. Analysis and interpretation: C. Huynh, G.A. Whitmore and S.D. Aaron. Drafting the manuscript for important intellectual content: C. Huynh, G.A. Whitmore, S.D. Aaron, K.L. Vandemheen, J.M. FitzGerald, C. Bergeron, C. Lemière, L-P. Boulet, A. Cote, E. Penz, S.K. Field, S. Gupta, R.A. McIvor, I. Mayers, M. Bhutani, P. Hernandez, M.D. Lougheed, M. Ainslie, C.J. Licskai, T. Azher, I. Fraser, M. Mahdavian, G.G. Alvarez and T. Kendzerska.
Conflict of interest: C. Huynh reports no conflicts of interest. G.A. Whitmore reports no conflicts of interest. K.L. Vandemheen reports no conflicts of interest. J.M. FitzGerald reports no conflicts of interest. C. Bergeron reports no conflicts of interest. L-P. Boulet reports receiving grants, consulting fees or honoraria from Amgen, AstraZeneca, GlaxoSmithKline, Merck, Novartis and Sanofi-Regeneron. A. Cote reports receiving honoraria from GlaxoSmithKline, AstraZeneca, Sanofi and Covis. S.K. Field reports receiving consulting fees or honoraria from Merck, GlaxoSmithKline, Novartis and Boehringer Ingelheim. E. Penz reports receiving honoraria from AstraZeneca, GlaxoSmithKline, Novartis, ICEBM and Boehringer Ingelheim. R.A. McIvor reports no conflicts of interest. C. Lemière reports receiving consulting fees or honoraria from Sanofi, TEVA, GlaxoSmithKline and AstraZeneca. S. Gupta reports no conflicts of interest. I. Mayers reports no conflicts of interest. M. Bhutani reports payments or honoraria from AZ, GSK, Novartis, Grifols, Sanofi, Covis and Valeo. P. Hernandez reports payments or honoraria from AZ, GSK, Novartis and Valeo. M.D. Lougheed reports receiving grants from AZ and GSK. C.J. Licskai reports receiving honoraria from AstraZeneca, GlaxoSmithKline, Novartis and Boehringer Ingelheim. T. Azher reports no conflicts of interest. M. Ainslee reports receiving honoraria from Boehringer Ingelheim. I. Fraser reports no conflicts of interest. M. Mahdavian reports no conflicts of interest. G.G. Alvarez reports no conflicts of interest. T. Kendzerska reports speaker honoraria from AstraZeneca. S.D. Aaron reports sitting on advisory boards and honoraria payments from GlaxoSmithKline, Sanofi and AstraZeneca.
Support statement: This work was supported by the Canadian Institutes of Health Research, FDN grant number 154322. Funding information for this article has been deposited with the Crossref Funder Registry.
- Received December 24, 2021.
- Accepted March 7, 2022.
- Copyright ©The authors 2022. For reproduction rights and permissions contact permissions{at}ersnet.org
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