Diagnostic accuracy of clinical symptoms in obstructive airway diseases varied within different health care sectors

Schneider, Antonius; Ay, Mehtap; Faderl, Bernhard; Linde, Klaus; Wagenpfeil, Stefan

doi:10.1016/j.jclinepi.2011.12.014

Cited by 19 publications

(18 citation statements)

References 25 publications

(30 reference statements)

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“…Given the high number of subjects with wheeze (24.6% using the GOLD definition and 31.3% with the LLN definition), we cannot exclude that asthma was also underdiagnosed or underreported in our population. However, wheezing is often also associated with COPD [24] and the results did not change significantly when the analysis was performed in the subjects not reporting wheezing (data nor shown).…”

Section: Discussionmentioning

confidence: 99%

Validity of a questionnaire-based diagnosis of chronic obstructive pulmonary disease in a general population-based study

et al. 2014

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BackgroundThe diagnosis of chronic obstructive pulmonary disease (COPD) is based on airflow obstruction. In epidemiological studies, spirometric data have often been lacking and researchers have had to rely almost solely on questionnaire answers. The aim of this study is to assess the diagnostic accuracy of questionnaire answers to detect COPD.MethodsA sample of the Swedish general population without physician-diagnosed asthma was randomly selected and interviewed using a respiratory questionnaire. All eligible subjects aged 25–75 years (n = 3892) performed spirometry for detection of airflow obstruction using Global Initiative for Chronic Obstructive Lung Disease (GOLD) or American Thoracic Society (ATS)/European Respiratory Society (ERS) criteria. Sensitivity, specificity, positive likelihood ratio (LR+), positive predictive values (PPVs), and negative predictive values (NPVs) were calculated to define diagnostic accuracy of questionnaire answers.ResultsThe sensitivity of the question “Have you been diagnosed by a physician as having COPD or emphysema?” in detecting airflow obstruction was 5.7% using GOLD, and 9.8% using ATS/ERS, criteria; specificity was 99.7% for GOLD and 99.5% for ATS/ERS. Sensitivity, specificity, and PPV were higher for the question compared to self-reported symptoms of chronic bronchitis in identifying subjects with airflow obstruction.ConclusionsThe high specificity and good PPV suggest that the question “Have you been diagnosed by a physician as having COPD or emphysema?” is more likely to identify those who do not have airflow obstruction, whereas the low sensitivity of this question could underestimate the real burden of COPD in the general population.

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Section: Discussionmentioning

confidence: 99%

Validity of a questionnaire-based diagnosis of chronic obstructive pulmonary disease in a general population-based study

et al. 2014

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“…Based on a previous study, we estimated the pre-test probability of asthma as 35%. 20 Moreover, using a chemoluminescence NO analyser and a cut-off value of 46 ppb, FENO sensitivity had been found to be 32% and specificity 93%. 13 Power calculations based on this showed that we needed at least 302 patients to determine sensitivity and specificity with 95% confidence intervals of AE9%.…”

Section: Design and Samplementioning

confidence: 98%

FENO measurement and sputum analysis for diagnosing asthma in clinical practice

Schneider

Schwarzbach

Faderl

et al. 2013

Respiratory Medicine

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“…Investigation of the diagnostic accuracy of clinical signs and symptoms (CSS) showed that these were not very effective in ruling in or ruling out the disease. 1 2 Spirometry is considered a reference standard for diagnosing airway obstruction, 3 but it is not possible to rule out milder forms of asthma, as obstruction is not present in these cases. 4 Guidelines also suggest the use of peak flow variability to diagnose BHR, 5 but its diagnostic accuracy is low.…”

Section: Introductionmentioning

confidence: 99%

Influence of the practice setting on diagnostic prediction rules using FENO measurement in combination with clinical signs and symptoms of asthma

et al. 2015

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ObjectivesTo evaluate the influence of the practice setting on diagnostic accuracy of fractional exhaled nitric oxide (FENO) for diagnosing asthma; and to develop prediction rules for diagnostic decision-making including clinical signs and symptoms (CSS).SettingPatients from 10 general practices and 1 private practice of 5 pneumologists in ambulatory care.Participants553 patients, 57.9% female. Consecutive inclusion of diagnostic-naive patients suspected of suffering from obstructive airway disease. Exclusion criteria were respiratory tract infections within the last 6 weeks.InterventionsThe index test was FENO measurement. Reference standard was the Tiffeneau ratio (forced expiratory volume in 1 s/vital capacity) or airway resistance as assessed by whole body plethysmography, with additional bronchoprovocation or bronchodilator testing.Primary and secondary outcome measuresAsthma as determined by pneumologists, who were blind to FENO measurement results. Prediction rules were derived from multiple logistic regression analysis. A freely available calculator that allows computing all combinations was developed.ResultsThe practice setting only had minor influence on sensitivities of FENO cut-off points. In the final model (n=472), allergic rhinitis, wheezing and previous medication were positively associated with asthma. Increasing age and recurrent respiratory tract infections were negatively associated. The area under the curve (AUC) of FENO (AUC=0.650; 95% CI 0.599 to 0.701) increased significantly (p<0.0001) when combined with CSS (AUC=0.753; 95% CI 0.707 to 0.798). Presence of wheezing and allergic rhinitis allowed ruling in asthma with FENO >30 ppb. Ruling out with FENO <16 ppb in patients <43 years was only possible without allergic symptoms when recurrent respiratory tract infections were present.ConclusionsFENO results should be interpreted in the context of CSS to enhance their diagnostic value in primary care. The final diagnostic model appears as a sound algorithm fitting well to the established diagnostic rules related to CSS of asthma. FENO appears more effective for ruling in asthma than for ruling it out.

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Diagnostic accuracy of clinical symptoms in obstructive airway diseases varied within different health care sectors

Cited by 19 publications

References 25 publications

Validity of a questionnaire-based diagnosis of chronic obstructive pulmonary disease in a general population-based study

Validity of a questionnaire-based diagnosis of chronic obstructive pulmonary disease in a general population-based study

FENO measurement and sputum analysis for diagnosing asthma in clinical practice

Influence of the practice setting on diagnostic prediction rules using FENO measurement in combination with clinical signs and symptoms of asthma

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