RT Journal Article
SR Electronic
T1 LATE-BREAKING ABSTRACT: A novel approach for identifying patients with undiagnosed clinically-significant COPD
JF European Respiratory Journal
JO Eur Respir J
FD European Respiratory Society
SP OA3284
DO 10.1183/13993003.congress-2015.OA3284
VO 46
IS suppl 59
A1 Fernando Martinez
A1 David M. Mannino
A1 Nancy K. Leidy
A1 Karen G. Malley
A1 Elizabeth D. Bacci
A1 R. Graham Barr
A1 Russ P. Bowler
A1 Meilan K. Han
A1 Julia F. Houfek
A1 Barry J. Make
A1 Catherine A. Meldrum
A1 Stephen Rennard
A1 Byron M. Thomashow
A1 John W. Walsh
A1 Barbara P. Yawn
YR 2015
UL http://erj.ersjournals.com/content/46/suppl_59/OA3284.abstract
AB 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.