Diagnostic accuracy of pre-bronchodilator FEV1/FEV6 from microspirometry to detect airflow obstruction in primary care: a randomised cross-sectional study

Bemt, Lisette van den; Wouters, Bram C W; Grootens, Joke; Denis, Joke; Poels, Patrick; Schermer, Tjard

doi:10.1038/npjpcrm.2014.33

Cited by 27 publications

(29 citation statements)

References 23 publications

(39 reference statements)

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“…The second study evaluated the NPV of handheld flow meters among a small sample (n=54) of ex-smokers aged ≥50 years who had been referred for diagnostic spirometry by their GP. 33 The NPV was estimated at 94.4% (95% CI 86.4% to 98.5%) when using the fixed ratio of FEV 1 /forced vital capacity (FVC) <0.7 to define airflow obstruction. Both findings are in keeping with our meta-analyses.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic accuracy of screening tests for COPD: a systematic review and meta-analysis

et al. 2015

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BackgroundChronic obstructive pulmonary disease (COPD) is widely underdiagnosed. A number of studies have evaluated the accuracy of screening tests for COPD, but their findings have not been formally summarised. We therefore sought to determine and compare the diagnostic accuracy of such screening tests in primary care.MethodsSystematic review and meta-analysis of the diagnostic accuracy of screening tests for COPD confirmed by spirometry in primary care. We searched MEDLINE, EMBASE and other bibliographic databases from 1997 to 2013 for diagnostic accuracy studies that evaluated 1 or more index tests in primary care among individuals aged ≥35 years with no prior diagnosis of COPD. Bivariate meta-analysis of sensitivity and specificity was performed where appropriate. Methodological quality was assessed independently by 2 reviewers using the QUADAS-2 tool.Results10 studies were included. 8 assessed screening questionnaires (the COPD Diagnostic Questionnaire (CDQ) was the most evaluated, n=4), 4 assessed handheld flow meters (eg, COPD-6) and 1 assessed their combination. Among ever smokers, the CDQ (score threshold ≥19.5; n=4) had a pooled sensitivity of 64.5% (95% CI 59.9% to 68.8%) and specificity of 65.2% (52.9% to 75.8%), and handheld flow meters (n=3) had a sensitivity of 79.9% (95% CI 74.2% to 84.7%) and specificity of 84.4% (68.9% to 93.0%). Inadequate blinding between index tests and spirometry was the main risk of bias.ConclusionsHandheld flow meters demonstrated higher test accuracy than the CDQ for COPD screening in primary care. The choice of alternative screening tests within whole screening programmes should now be fully evaluated.PROSPERO registration numberCRD42012002074.

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Section: Discussionmentioning

confidence: 99%

Diagnostic accuracy of screening tests for COPD: a systematic review and meta-analysis

et al. 2015

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“…Guidelines recommend that three reproducible spirometry readings should be produced (van den Bemt et al, 2014), and must meet criteria from relevant guidelines (Levy et al, 2010;Sansores et al, 2013;Celli et al, 2015;Roberts et al, 2016;Kotaki et al, 2017), by well-trained staff (Spyratos et al, 2012). In addition, relevant literature states that 400 micrograms of albuterol or salbutamol is the recommended dose for postbronchodilator spirometry (Miller et al, 2005;Weiss et al, 2014;van den Bemt et al, 2014).…”

Section: Correctly Defining Airway Obstructionmentioning

confidence: 99%

“…Some studies state that for pre-bronchodilator microspirometry, a fixed cut-off point of FEV1/FEV6 <0.73 is now preferred over the previous FEV1/FVC <0.70 to indicate airflow obstruction in pre-bronchodilator microspirometry (van den Bemt et al, 2014). This was suggested due to patients with COPD being missed, as the cut-off point was too low (Thorn et al, 2012).…”

Section: Correctly Defining Airway Obstructionmentioning

confidence: 99%

What factors influence an early COPD diagnosis in primary care?

Mercy

Fotis

2018

Practice Nursing

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This systematic literature review aimed to identify factors influencing late- and under-diagnosis of COPD in primary care Background: There are millions of people living with chronic obstructive pulmonary disease (COPD) who have not been diagnosed. Patients have regularly lost half of their lung function by the point of diagnosis, and therefore there are fewer interventions available. Aim: The aim of this systematic literature review was to identify factors influencing late- and under-diagnosis of COPD in primary care. This includes considering the current methods of COPD screening, and whether early screening would benefit diagnostic rates. Methods: A comprehensive, systematic literature search was undertaken using the following databases: BNI, CINAHL, Medline, NHS Evidence, PubMed, ScienceDirect, Wiley Online. Following this, a critical review of the literature was performed on 10 relevant articles. A thematic analysis followed. Results: There is a significant lack of up-to-date research on COPD screening and early detection. Generalised screening versus case-finding may be a method of identifying the undiagnosed population; however, evidence needs to improve. There is a lack of COPD education in healthcare and wider society. COPD among women is on the rise, yet they are less likely to be identified. There is a necessity for guidance and research to be provided. Screening is likely to be the future preferred method for identifying those undiagnosed, but research needs to identify the benefits of screening versus casefinding. Conclusion: The findings can be applied to primary care nursing, to combat COPD under-diagnosis.

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“… 12 Several studies have concluded that hand-held screening devices including the COPD-6 and PiKo-6 device are reliable in screening for airway obstruction and selecting subjects for further diagnostic workup. 13 – 20 A recent meta-analysis concluded that the accuracy of FEV 1 /FEV 6 measured by hand-held devices seems to be lower than spirometry, but sufficiently accurate to screen for airway obstruction. 21 …”

Section: Introductionmentioning

confidence: 99%

Multicenter study of the COPD-6 screening device: feasible for early detection of chronic obstructive pulmonary disease in primary care?

Kjeldgaard¹,

Lykkegaard²,

Spillemose³

et al. 2017

COPD

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Background and aimEarly detection of COPD may reduce the future burden of the disease. We aimed to investigate whether prescreening with a COPD-6 screening device (measuring FEV1 and FEV6) facilitates early detection of COPD in primary care.MethodsIn primary care, individuals at high risk of COPD (ie, age ≥35 years, relevant exposure, and at least one respiratory symptom) and no previous diagnosis of obstructive lung disease were examined with a COPD-6 screening device. In prioritized order, the criteria for proceeding to confirmatory spirometry were FEV1/FEV6 <0.7, FEV1 <80%pred, or clinical suspicion of COPD regardless of test result (medical doctor’s [MD] decision). Based on spirometry, including bronchodilator (BD) reversibility test, individuals were classified as COPD (post-BD FEV1/FVC <0.70), asthma (ΔFEV1 ≥0.50 L), or no obstructive lung disease.ResultsA total of 2,990 subjects (54% men, mean age 59 years, and mean 28 pack-years) were enrolled, of whom 949 (32%) proceeded from COPD-6 screening to confirmative spirometry based on the following criteria: 510 (54%) FEV1/FEV6 <0.70, 382 (40%) FEV1 <80%pred, and 57 (6%) MD decision. Following confirmative spirometry, the 949 individuals were diagnosed as having COPD (51%), asthma (3%), and no obstructive lung disease (45%). COPD was diagnosed in 487 (16%) of the enrolled subjects in whom confirmative spirometry was performed in 69% based on FEV1/FEV6 <0.7 and in 29% based on FEV1 ≤80%pred.ConclusionPrescreening with the COPD-6 device showed acceptable specificity for the selection of subjects for diagnostic spirometry and is likely to be a useful alternative to current practice in primary care.

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Diagnostic accuracy of pre-bronchodilator FEV1/FEV6 from microspirometry to detect airflow obstruction in primary care: a randomised cross-sectional study

Cited by 27 publications

References 23 publications

Diagnostic accuracy of screening tests for COPD: a systematic review and meta-analysis

Diagnostic accuracy of screening tests for COPD: a systematic review and meta-analysis

What factors influence an early COPD diagnosis in primary care?

Multicenter study of the COPD-6 screening device: feasible for early detection of chronic obstructive pulmonary disease in primary care?

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