TY - JOUR T1 - LATE-BREAKING ABSTRACT: A novel approach for identifying patients with undiagnosed clinically-significant COPD JF - European Respiratory Journal JO - Eur Respir J DO - 10.1183/13993003.congress-2015.OA3284 VL - 46 IS - suppl 59 SP - OA3284 AU - Fernando Martinez AU - David M. Mannino AU - Nancy K. Leidy AU - Karen G. Malley AU - Elizabeth D. Bacci AU - R. Graham Barr AU - Russ P. Bowler AU - Meilan K. Han AU - Julia F. Houfek AU - Barry J. Make AU - Catherine A. Meldrum AU - Stephen Rennard AU - Byron M. Thomashow AU - John W. Walsh AU - Barbara P. Yawn Y1 - 2015/09/01 UR - http://erj.ersjournals.com/content/46/suppl_59/OA3284.abstract N2 - Background: COPD is underdiagnosed, often uncovered during exacerbations or after significant loss of lung function. We are developing a new method (simple questionnaire + peak expiratory flow [PEF]) for identifying patients needing spirometric evaluation for clinically significant COPD (FEV1 <60% pred) or at risk of acute exacerbation (AECOPD) in general practice. 46 candidate questions were created based on literature, mining existing datasets, and qualitative research.Purpose: This study used random forests (RF) to identify the best, smallest set of questions (with and without PEF) capable of case identification.Methods: Prospective, cross-sectional, multi-site, case-control study. Subjects: ≥40 years from US pulmonary and primary care clinics. Cases (clinically significant COPD): ≥1 AECOPD past 12 months or FEV1 <60% pred and AECOPD-free ≥12 months. Controls: mild COPD (FEV1 >60% pred) and AECOPD-free ≥12 months or no COPD. Subjects completed questionnaires, PEF, spirometry (if not on record).Results: N=346; 186 Cases (184 with PEF), 160 Controls. Mean (SD) age=62.7 (10.1) years; 55% female; 86% white; 41% ≤high school; 16% never smoked. Cases: mean (SD) FEV1% pred=42.5(14.2); Controls=82.5(15.7). RF case-control sensitivity/specificity estimates for the final 5-item questionnaire: 83.5/69.7; questionnaire followed by score-driven use of PEF: 90.2/78.8%. Case-no COPD with score-driven PEF: 90.2/92.0. Questions ask about exposure, breathing, tire easily, and acute respiratory illness, and do not ask about smoking, cough, or sputum.Conclusions: These 5 questions + selective use of PEF may be an effective and efficient approach for identifying patients needing diagnostic evaluation for COPD. ER -