Detection of airflow limitation using a handheld spirometer in a primary care setting

Ching, Siew Mooi; Pang, Yong‐Kek; Price, David; Cheong, Ai Theng; Lee, Ping Yein; Irmi, Ismail; Hassan, Faezah; Ruhaini, Ismail; Chia, Yook Chin

doi:10.1111/resp.12291

Cited by 20 publications

(31 citation statements)

References 25 publications

(52 reference statements)

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“…Our analysis did not show an association of COPD diagnosis with ethnicity, and the current tool may lack the sensitivity to discern such differences. We showed our population estimates of COPD at around 3.4% to 6.5%, a figure lower than most BOLD sites, similar to another Malaysian site by Ching SM and colleagues published last year and that from theoretical projections by Tan WC and colleagues 12 years ago . Our findings of biomass burning and dusty job exposure as risk factors in COPD reiterate their increasingly important role for COPD screening, treatment and prevention in this part of the world.…”

Section: Discussionsupporting

confidence: 83%

“…Early stage COPD can be difficult to diagnose or suspect in the absence of cigarette smoking. In a recent primary care study of 416 participants in Malaysia, the handheld spirometer (COPD‐6) could detect airflow limitation in 10% of the sampled outpatient clinic participants compared with a 6% rate gauged by the standard spirometer, suggesting that handheld spirometers can screen for COPD in primary care . Screening questionnaires can also be improved to include questions on biomass burning and dusty jobs.…”

Section: Discussionmentioning

confidence: 99%

“…The Global Burden of Disease study ranked COPD as the seventh most common cause of premature death in Malaysia for 2010 . A recent primary care study in Malaysia estimated a prevalence of airflow obstruction at 6% . There are to date no published robust population‐based epidemiology data from Malaysia of COPD.…”

Section: Introductionmentioning

confidence: 99%

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Low prevalence of obstructive lung disease in a suburban population of Malaysia: A BOLD collaborative study

et al. 2016

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Background and objective: As a Burden of Obstructive Lung Disease (BOLD) collaboration, we studied the prevalence of chronic obstructive pulmonary disease (COPD) and its associated risk factors in a suburban population in Malaysia. Methods: Nonhospitalized men or women of age ≥ 40 years from a Penang district were recruited by stratified simple random sampling. Participants completed detailed questionnaires on respiratory symptoms and exposure to COPD risk factors. Prebronchodilator and post-bronchodilator spirometry conducted was standardized across all international BOLD sites in device and data quality control. Results: Of the 1218 individuals recruited for the study, 663 (340 men and 323 women) had complete questionnaire data and acceptable post-bronchodilator spirometry. The estimated population prevalence of Global Initiative for Chronic Obstructive Lung Disease (GOLD) ≥ stage I was 6.5% or 3.4% based on either fixed forced expiratory volume in 1 s/forced vital capacity ratio of <0.7 or National Health and Nutritional Examination Survey-derived lower limit of normal ratio while the prevalence of GOLD ≥ stage II was either 4.6% or 3.1%, respectively. Multivariate logistic regression analysis showed independent association between all stages of COPD with cigarette smoking pack years (adjusted odds ratio per 10-year increase: 1.73; 95% confidence interval: 1.09-2.75), use of biomass fuel for cooking (1.61; 1.10-2.36) and exposure to dusty job (1.50; 1.09-2.06). Conclusion: This study represented the first robust population-based epidemiology data on COPD for Malaysia. Compared with other sites globally, our estimated population prevalence was relatively low. In addition to cigarette smoking, use of biomass fuel and exposure to dusty job represented significant risk to the development of COPD.

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Section: Discussionsupporting

confidence: 83%

Section: Discussionmentioning

confidence: 99%

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Low prevalence of obstructive lung disease in a suburban population of Malaysia: A BOLD collaborative study

et al. 2016

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“…This accreditation process will devise uniform activities and documents that will serve as measurable criteria for the institutions that train health professionals in spirometry. In addition, there are valid alternatives that help clinical identify those patients at high risk, including questionnaires, different screening tools , and in different point of care settings , …”

Section: Disability‐adjusted Life Year (Daly)mentioning

confidence: 99%

Global burden of COPD

2015

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It is estimated that the world population will reach a record 7.3 billion in 2015, and the high burden of chronic conditions associated with ageing and smoking will increase further. Respiratory diseases in general receive little attention and funding in comparison with other major causes of global morbidity and mortality.In particular, chronic obstructive pulmonary disease (COPD) has been a major public health problem and will remain a challenge for clinicians within the 21st century. Worldwide, COPD is in the spotlight, since its high prevalence, morbidity and mortality create formidable challenges for health-care systems. This review emphasizes the magnitude of the COPD problem from a clinician's standpoint by drawing extensively from the new findings of the Global Burden of Disease study. Updated,distilled information on the population distribution of COPD is useful for the clinician to help provide an appreciation of the relative impact of COPD in daily practice compared with other chronic conditions, and to allocate minimum resources in anticipation of future needs in care. Despite recent trends in reduction of COPD standardized mortality rates and some recent successes in anti-smoking efforts in a number of Western countries, the overarching demographic impact of ageing in an ever-expanding world population, joined with other factors such as high rates of smoking and air pollution in Asia, will ensure that COPD will continue to pose an ever-increasing problem well into the 21st century.

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“…In places where spirometry is not available such as in remote areas, alternative options to the doctor visit include COPD questionnaires followed by the use of handheld spirometric devices (HSDs) as a guide in choosing the correct treatment for the patient. 17 – 19 According to the Global initiative for chronic Obstructive Lung Disease (GOLD), there are four stages of COPD, based on the air flow limitation at forced expiratory volume in 1 second (FEV1) on the spirometry test. Simple validated questionnaires, such as the COPD Population Screener (COPD-PS) questionnaire, 20 Diagnostic Score for COPD (DS-COPD), 21 and the International Primary Care Airways Guidelines (IPAG) questionnaire 12 , 15 have been developed, and HSDs (Vitalograph COPD-6 22 and the PiKo-6 12 , 23 ) have been shown to provide a precise screening tool for people at risk of developing COPD.…”

Section: Introductionmentioning

confidence: 99%

VitalQPlus: a potential screening tool for early diagnosis of COPD

Sui¹,

Ming²,

Neoh³

et al. 2015

COPD

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BackgroundThis study utilized a validated combination of a COPD Population Screener (COPD-PS) questionnaire and a handheld spirometric device as a screening tool for patients at high risk of COPD, such as smokers. The study aimed to investigate and pilot the feasibility and application of this combined assessment, which we termed the “VitalQPlus”, as a screening tool for the early detection of COPD, especially in primary care settings.MethodsThis was a cross-sectional study screening potentially undiagnosed COPD patients using a validated five-item COPD-PS questionnaire together with a handheld spirometric device. Patients were recruited from selected Malaysian government primary care health centers.ResultsOf the total of 83 final participants, only 24.1% (20/83) were recruited from Perak and Penang (peninsular Malaysia) compared to 75.9% (63/83) from Sabah (Borneo region). Our dual assessment approach identified 8.4% of the surveyed patients as having potentially undiagnosed COPD. When only the Vitalograph COPD-6 screening tool was used, 15.8% of patients were detected with a forced expiratory volume in 1 second/forced expiratory volume in 6 seconds (FEV1/FEV6) ratio at <0.75, while 35.9% of patients were detected with the COPD-PS questionnaire. These findings suggested that this dual assessment approach has a greater chance of identifying potentially undiagnosed COPD patients compared to the Vitalograph COPD-6 or COPD-PS questionnaire when used alone. Our findings show that patients with more symptoms (scores of ≥5) yielded twice the percentage of outcomes of FEV1/FEV6 <0.75 compared to patients with fewer COPD symptoms (scores <5).ConclusionWith the availability of a simple screening questionnaire and the COPD-6, there is an opportunity easily to make patients more aware of their lung symptoms and to encourage the provision of early treatment. The proposed dual assessment approach, which we termed the VitalQPlus, may play a profound role in the early diagnosis of COPD, which is crucial in improving the clinical management of the disease.

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Detection of airflow limitation using a handheld spirometer in a primary care setting

Cited by 20 publications

References 25 publications

Low prevalence of obstructive lung disease in a suburban population of Malaysia: A BOLD collaborative study

Low prevalence of obstructive lung disease in a suburban population of Malaysia: A BOLD collaborative study

Global burden of COPD

VitalQPlus: a potential screening tool for early diagnosis of COPD

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