Background: Symptom-based questionnaires may enhance chronic obstructive pulmonary disease (COPD) screening in primary care. Objectives: We prospectively tested questions to help identify COPD among smokers without prior history of lung disease. Methods: Subjects were recruited via random mailing to primary care practices in Aberdeen, UK, and Denver, Colo., USA. Current and former smokers aged 40 or older with no prior respiratory diagnosis and no respiratory medications in the past year were enrolled. Participants answered questions covering demographics and symptoms and then underwent spirometry with reversibility testing. A study diagnosis of COPD was defined as fixed airway obstruction as measured by postbronchodilator FEV₁/FVC <0.70. We examined the ability of individual questions in a multivariate framework to correctly discriminate between persons with and without COPD. Results: 818 subjects completed all investigations and proceeded to analysis. The list of 54 questions yielded 52 items for analysis, which was reduced to 17 items for entry into multivariate regression. Eight items had significant relationships with the study diagnosis of COPD, including age, pack-years, body mass index, weather-affected cough, phlegm without a cold, morning phlegm, wheeze frequency, and history of any allergies. Individual items yielded odds ratios ranging from 0.23 to 12. This questionnaire demonstrated a sensitivity of 80.4 and specificity of 72.0. Conclusions: A simple patient self-administered questionnaire can be used to identify patients with a high likelihood of having COPD, for whom spirometric testing is particularly important. Implementation of this questionnaire could enhance the efficiency and diagnostic accuracy of current screening efforts.

This Diagnosis paper constitutes the second of the IPCRG Guideline papers on the management of chronic respiratory diseases in primary care. Primary care health professionals are usually the first point of contact for patients who can present a wide range of initial symptoms which may or may not constitute their first presentation of a chronic disease such as asthma, COPD, or rhinitis. This paper is focussed upon the early identification and diagnosis of chronic respiratory diseases in primary care. It uses a symptom-based approach, and includes original questionnaires and diagnostic guides to help the primary care clinician proceed systematically through the diagnostic process.

Background: Many patients with obstructive lung disease (OLD) carry an inaccurate diagnostic label. Symptom-based questionnaires could identify persons likely to need spirometry. Objectives: We prospectively tested questions derived from a comprehensive literature review and an international Delphi panel to help identify chronic OLD (COPD) in persons with prior evidence of OLD. Methods: Subjects were recruited via random mailing to primary-care practices in Aberdeen, Scotland, and Denver, Colorado. Persons aged 40 and older reporting any prior diagnosis of OLD or any respiratory medications in the past year were enrolled. Participants answered 54 questions covering demographics and symptoms and underwent spirometry with reversibility testing. A study diagnosis of COPD was defined by fixed airway obstruction as measured by post-bronchodilator FEV₁/FVC <0.70. We examined ability of individual questions in a multivariate framework to discriminate between persons with and without the study diagnosis of COPD. Results: 597 persons completed all investigations and proceeded to analysis. The list of 54 questions yielded 52 items for analyses, which was reduced to 19 items for entry into a multivariate regression model. Nine items had significant relationships with the study diagnosis of COPD, including increased age, pack-years, worsening cough, breathing-related disability or hospitalization, worsening dyspnea, phlegm quantity, cold going to the chest, and receipt of treatment for breathing. Individual items yielded odds ratios ranging from 0.33 to 20.7. This questionnaire demonstrated a sensitivity of 72.0 and a specificity of 82.7. Conclusions: A short, symptom-based questionnaire identifies persons more likely to have COPD among persons with prior evidence of OLD.

age are susceptible to infection and disease. [1][2][3] Complications of HAV infection occur more frequently in older persons 4 and case fatalities of up to 12.8% have been reported. 5 Hepatitis B is one of the most important vaccine-preventable illnesses and hence WHO has recommended in the early 1990s the incorporation of vaccination against the hepatitis B virus (HBV) into national immunization programs for children. 6 Previous studies on hepatitis A and hepatitis B vaccination, although seldom carried out on elderly people, mostly showed a HAV protection rate of about 98% and a HBV protection rate of about 95%. [7][8][9][10][11] Often combined HAV/HBV vaccines were slightly more effective than their monovalent counterparts. 7,8,10,12 Besides other factors 13 an effect of age on the success of vaccination against hepatitis B has long been suspected, 14,15 whereas the effect of age on HAV seroprotection rates is not well documented.In a previous publication, we reported a failure of combined vaccination against hepatitis A and B in a cohort of more than 100 elderly individuals from a single medical practice that was enrolled in a retrospective survey. After completion of three doses of Twinrix ® under so-called every day conditions the subjects were recalled to give a fresh serum sample 1-36 month (average 16.8) and only 35% of all individuals developed antibodies against both viruses. Furthermore, only 29% and 65% of the vaccinees older than 40 years were protected against HBV and HAV infection, respectively. 16 However, the results of this investigation have been controversially discussed. The retrospective study design, as well as the fact that the period between the completion of vaccination and the antibody testing was exceptionally long, were aspects which have been criticized in particular. 17 After inspection by the German regulatory authority, no reason was found to explain the low seroprotection rate. In cooperation with the European regulatory authority they requested further investigation to prove the potential of the vaccine.To meet all these criticisms, we have conceived a multicenter study consisting of both a prospective and a retrospective cohort in order to re-examine the success of the combined hepatitis A and hepatitis B vaccine Twinrix ® in general and to re-evaluate in particular the potential impact of age of the subjects that might cause lower HAV and HBV seroprotection rates.In the past, immunogenicity of hepatitis A and B vaccines needed to be questioned in persons of advanced age, especially in those of 40 years and older.We performed a comparative multicenter prospective and retrospective study with the combined hepatitis A and B vaccine Twinrix ® to identify factors influencing the results of the vaccination in a population of all age groups.Out of 489 subjects enrolled, 241 were vaccinated in a prospective study (group 1) and 248 subjects in a retrospective study (group 2) in 17 German centers with median age of 40.1 (14-79) years.Following three applications of the combined hepat...

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