Diagnostic Accuracy of a Two-Stage Sequential Screening Strategy Implemented by Community Health Workers (CHWs) to Identify Individuals with COPD in Rural India

Abstract

Purpose Undiagnosed Chronic Obstructive Pulmonary Disease (COPD) results in high morbidity, disability and mortality in India. Effective strategies for active COPD screening in community settings are needed to increase early identification, risk reduction and timely management. The objective of this study was to test the diagnostic accuracy of a sequential two-step screening strategy to detect COPD, implemented by community health workers (CHWs), among adults aged ≥40 years in a rural area of North India. Patients and Methods Trained CHWs screened all consenting (n=3256) eligible adults in two villages using the Lung Function Questionnaire (LFQ) to assess their COPD risk and conducted pocket spirometry on 268 randomly selected (132 with high risk ie LFQ score ≤18 and 136 with low risk ie LFQ score >18) individuals. Subsequently, trained researchers conducted post-bronchodilator spirometry on these randomly selected individuals using a diagnostic quality spirometer and confirmed the COPD diagnosis according to the Global Initiative for Obstructive Lung Disease (GOLD) criteria (FEV 1 /FVC ratio <0.7). Results This strategy of using LFQ followed by pocket spirometry was sensitive (78.6%) and specific (78.8%), with a positive predictive value of 66% and negative predictive value of 88%. It could accurately detect 67% of GOLD Stage 1, 78% of GOLD Stage 2, 82% of GOLD Stage 3 and 100% of GOLD Stage 4 individuals with airflow limitation. Conclusion COPD can be accurately detected by trained CHWs using a simple sequential screening strategy. This can potentially contribute to accurate assessment of COPD and thus its effective management in low-resource settings.

Accuracy of Six Chronic Obstructive Pulmonary Disease Screening Questionnaires in the Chinese Population

“…Jarhyan applied it in community settings and showed 75.0% sensitivity and 55.3% specificity at a cut-off score of 18 points, which were not as good as the present study. 31 A survey enrolled smokers ≧40 years old and found that the optimal cut-off value of LFQ based on the Youden method was 18 points, which is higher than ours. It may be that it was conducted in the smoking population, and the year of smoking is one of the indicators of LFQ.…”

Prevalence of chronic obstructive pulmonary disease and chronic bronchitis in eight countries: a systematic review and meta-analysis

“…Some studies have suggested screening strategies for early detection of COPD. 84 , 85 However, COPD screening needs further evaluation and feasibility studies and should be supported by strengthening of public health infrastructure for the confirmation of diagnosis, early initiation of pharmacological and non-pharmacological treatment including pulmonary rehabilitation. 85 …”

Health of the Working Rural Population as a Social Problem of Modern Society

“…Управление лечебно-диагностическими мероприятиями является сложным и многоступенчатым процессом, играет важную роль в обеспечении качественного и своевременного оказания медицинской помощи. Одним из наиболее важных этапов этого процесса служат успешное прогнозирование и раннее выявление заболеваний, связанных с профессиональной деятельностью [25][26][27]…”