Development and Initial Validation of a Self-Scored COPD Population Screener Questionnaire (COPD-PS)

Abstract

COPD has a profound impact on daily life, yet remains underdiagnosed and undertreated. We set out to develop a brief, reliable, self-scored questionnaire to identify individuals likely to have COPD. COPD-PS TM development began with a list of concepts identified for inclusion using expert opinion from a clinician working group comprised of pulmonologists (n = 5) and primary care clinicians (n = 5). A national survey of 697 patients was conducted at 12 practitioner sites. Logistic regression identified items discriminating between patients with and without fixed airflow obstruction (AO, postbronchodilator FEV 1 /FVC < 70%). ROC analyses evaluated screening accuracy, compared scoring options, and assessed concurrent validity. Convergent and discriminant validity were assessed via COPD-PS and SF-12v2 score correlations. For known-groups validation, COPD-PS differences between clinical groups were tested. Test-retest reliability was evaluated in a 20% sample. Of 697 patients surveyed, 295 patients met expert review criteria for spirometry performance; 38% of these (n = 113) had results indicating AO. Five items positively predicted AO ( p < 0.0001): breathlessness, productive cough, activity limitation, smoking history, and age. COPD-PS scores accurately classified AO status (area under ROC curve = 0.81) and reliable (r = 0.91 MD, MSc, San Jacinto Methodist Hospital, Baytown, TX; Mary Issac, MD, MPH, St. Joseph's Community Care Hospital, Tampa, FL; Fernando J. Martinez, MD, MS, University of Michigan, Ann Arbor, MI; Phillip Menashe, MD, Yakima Chest Clinic, Yakima, WA; Anna W. Parkman, RRT, PhD, Ohio Dominican University, Columbus, OH; Michael A. Russoniello, MD, St. Clares Hospital, Denville, NJ; Frederic D. Seifer, MD, Takoma Adventist Hospital, Greeneville, TN. Correspondence to: Fernando J. Martinez, MD, MS, Division of Pulmonary and Critical Care Medicine, University of Michigan Health System, Ann Arbor, MI 48109 USA; email: fmartine@umich.edu COPD: Journal of Chronic Obstructive Pulmonary DiseaseApril 2008 85 AO scored significantly higher (6.8, SD = 1.9; p < 0.0001) than patients without AO (4.0, SD = 2.3). Higher scores were associated with more severe AO, bronchodilator use, and overnight hospitalization for breathing problems. With the prevalence of COPD in the studied cohort, a score on the COPD-PS of greater than five was associated with a positive predictive value of 56.8% and negative predictive value of 86.4%. The COPD-PS accurately classified physicianreported COPD (AUC = 0.89). The COPD-PS is a brief, accurate questionnaire that can identify individuals likely to have COPD.

Difficulty of Copd Predicting as a Challenge to Modern Clinical Pulmonology

“…В ходе крупных многоцентровых исследова-ний Garcia-Aymemerich (2003), Martinez (2006), Calverley (2007) продемонстрировано, что основны-ми причинами смертности при ХОБЛ являются ды-хательная недостаточность (25% -5%), сердечно-сосудистые заболевания (12% -0,5%) и рак легких (3% -0,01%) [8,15,30]. В ходе других исследований установлено, что ХОБЛ ассоциирована с более вы-соким риском развития гипертонии, атеросклероза, сердечной недостаточности, рака легких, остеопоро-за, метаболических расстройств, а вследствие этого, с более высоким риском смерти у данной категории больных [9,22,27,29,33].…”

Improving the Differential Diagnosis of Chronic Obstructive Pulmonary Disease in Primary Care

“…32,33 In screening questionnaires, dyspnea (particularly on exertion) and cough have been found to positively predict airflow obstruction. 32,34,35 Although similar symptoms may be present in asthma and COPD, those associated with COPD are usually persistent and worsen with disease severity, whereas those associated with asthma are variable and may even improve over time with removal of triggers.…”

“…32,33 In screening questionnaires, dyspnea (particularly on exertion) and cough have been found to positively predict airflow obstruction. 32,34,35 Although similar symptoms may be present in asthma and COPD, those associated with COPD are usually persistent and worsen with disease severity, whereas those associated with asthma are variable and may even improve over time with removal of triggers. 8,10 Patients with COPD are also more likely to have other chronic conditions, such as coronary artery disease, lung cancer, cor pulmonale, osteoporosis, and depression, 36 whereas the common coexisting conditions in asthma are more likely to be related to allergy.…”

Validation of the COPD Diagnostic Questionnaire in an Australian general practice cohort: a cross-sectional study

“…15,21 Other questionnaires such as the COPD Population Screener Questionnaire (COPD-PS) and a condensed version of the COPD Assessment Test (CAT) have been developed but have not undergone external validation. 13,14 The aim of this study was to validate the CDQ externally in a large sample of current and former smokers with no prior diagnosis of obstructive lung disease recruited from general practices in Sydney, Australia. We wanted to determine if the CDQ could be used as a COPD diagnostic tool in patients at increased risk in Australian general practice.…”

“…5 Several studies in different populations around the world have looked at devising a questionnaire for the diagnosis of COPD or, alternatively, using a questionnaire as a filter to select people at risk (such as tobacco smokers, passive tobacco exposure, and increasing age) for further investigation by spirometry. [9][10][11][12][13][14] The COPD Diagnostic Questionnaire (CDQ) is an eight-item tool designed by the COPD Questionnaire Study Group from a cross-sectional study of primary care patients aged >40 years from the UK and USA with a history of smoking but no prior respiratory diagnosis (see Appendix 1, available online at www.thepcrj.org). 11,12 It was developed to improve the efficiency and accuracy of COPD diagnosis in primary care by removing the need for spirometry in low-risk patients.…”