Do symptom-based questions help screen COPD among Chinese populations?

Zhang, Qun; Wang, Min; Li, Xiaona; Wang, Hong; Wang, Jianming

doi:10.1038/srep30419

Cited by 7 publications

(10 citation statements)

References 32 publications

(40 reference statements)

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“…The six index tests included four screening questionnaires: COPD Diagnostic Questionnaire (CDQ, cutpoint ≥20), 16 25 COPD Assessment in Primary Care To Identify Undiagnosed Respiratory Disease and Exacerbation Risk (CAPTURE) (cut-point ≥2), 26 COPD Screening Questionnaire (COPD-SQ, cut-point ≥16) 19 and the Chinese Symptom-Based Questionnaire (C-SBQ, cutpoint ≥17) 18 and two airflow measurement devices: microspirometry (Vitalograph COPD-6, cut-point for positive test forced expiratory volume in one second (FEV 1 )/ FEV 6 <0.78), 27 28 peak flow (model of peak flow meters used in the study (USPE), cut-point <350 L/min men, <250 L/min women). 26 Questionnaires were selected to maximise symptom capture and minimise item duplication, while allowing comparison of the most relevant questionnaires (online supplemental appendix 1).…”

Section: Index Testsmentioning

confidence: 99%

“…Furthermore, the majority of Chinese studies have used secondary or tertiary care COPD populations rather than people from community settings. 18 19 Finally, the cost-effectiveness of different screening tests have not been previously estimated in China; a crucial consideration given the high prevalence of COPD in this middleincome country.…”

Section: Introductionmentioning

confidence: 99%

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Accuracy and cost-effectiveness of different screening strategies for identifying undiagnosed COPD among primary care patients (≥40 years) in China: a cross-sectional screening test accuracy study: findings from the Breathe Well group

et al. 2021

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ObjectivesTo examine the accuracy and cost-effectiveness of various chronic obstructive pulmonary disease (COPD) screening tests and combinations within a Chinese primary care population.DesignScreening test accuracy study.SettingUrban and rural community health centres in four municipalities of China: Beijing (north), Chengdu (southwest), Guangzhou (south) and Shenyang (northeast).ParticipantsCommunity residents aged 40 years and above who attended community health centres for any reason were invited to participate. 2445 participants (mean age 59.8 (SD 9.6) years, 39.1% (n=956) male) completed the study (February–December 2019), 68.9% (n=1684) were never-smokers and 3.6% (n=88) had an existing COPD diagnosis. 13.7% (n=333) of participants had spirometry-confirmed airflow obstruction.InterventionsParticipants completed six index tests (screening questionnaires (COPD Diagnostic Questionnaire, COPD Assessment in Primary Care To Identify Undiagnosed Respiratory Disease and Exacerbation Risk (CAPTURE), Chinese Symptom-Based Questionnaire (C-SBQ), COPD-SQ), microspirometry (COPD-6), peak flow (model of peak flow meters used in the study (USPE)) and the reference test (ndd Easy On-PC).Primary and secondary outcomesCases were defined as those with forced expiratory volume in one second (FEV1)/forced vital capacity (FVC) below the lower limit of normal (LLN-GLI) on the reference test. Performance of individual screening tests and their combinations was evaluated, with cost-effectiveness analyses providing cost per additional true case detected.ResultsAirflow measurement devices (sensitivities 64.9% (95% CI 59.5% to 70.0%) and 67.3% (95% CI 61.9% to 72.3%), specificities 89.7% (95% CI 88.4% to 91.0%) and 82.6% (95% CI 80.9% to 84.2%) for microspirometry and peak flow, respectively) generally performed better than questionnaires, the most accurate of which was C-SBQ (sensitivity 63.1% (95% CI 57.6% to 68.3%) specificity 74.2% (95% CI 72.3% to 76.1%)). The combination of C-SBQ and microspirometry used in parallel maximised sensitivity (81.4%) (95% CI 76.8% to 85.4%) and had specificity of 68.0% (95% CI 66.0% to 70.0%), with an incremental cost-effectiveness ratio of £64.20 (CNY385) per additional case detected compared with peak flow.ConclusionsSimple screening tests to identify undiagnosed COPD within the primary care setting in China is possible, and a combination of C-SBQ and microspirometry is the most sensitive and cost-effective. Further work is required to explore optimal cut-points and effectiveness of programme implementation.Trial registration numberISRCTN13357135.

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Section: Index Testsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Accuracy and cost-effectiveness of different screening strategies for identifying undiagnosed COPD among primary care patients (≥40 years) in China: a cross-sectional screening test accuracy study: findings from the Breathe Well group

et al. 2021

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“…Four screening questionnaires will be used in the study; the COPD Diagnostic Questionnaire (CDQ), 17 30 the COPD Screening Questionnaire (COPD-SQ), 19 a symptom-based questionnaire 31 and COPD Assessment in Primary Care To Identify Undiagnosed Respiratory Disease and Exacerbation Risk Questionnaire (CAPTURE) 18 ( online supplemental appendix 1 ). The selection of questionnaires maximises symptoms being assessed and minimises duplication of items, while allowing comparison of the most relevant questionnaires.…”

Section: Methods and Analysismentioning

confidence: 99%

Study to evaluate the effectiveness and cost-effectiveness of different screening strategies for identifying undiagnosed COPD among residents (≥40 years) in four cities in China: protocol for a multicentre cross-sectional study on behalf of the Breathe Well group

et al. 2020

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IntroductionThe latest chronic obstructive pulmonary disease (COPD) epidemiology survey in China estimated that there were 99 million potential COPD patients in the country, the majority of whom are undiagnosed. Screening for COPD in primary care settings is of vital importance for China, but it is not known which strategy would be the most suitable for adoption in primary care. Studies have been conducted to test the accuracy of questionnaires, expiratory peak flow meters and microspirometers to screen for COPD, but no study has directly evaluated and compared the effectiveness and cost-effectiveness of these methods in the Chinese setting.Methods and analysisWe present the protocol for a multicentre cross-sectional study, to be conducted in eight community hospitals from four cities among Chinese adults aged 40 years or older to investigate the effectiveness and cost-effectiveness of different case-finding methods for COPD, and determine the test performance of individual and combinations of screening tests and strategies in comparison with quality diagnostic spirometry. Index tests are screening questionnaires (COPD Diagnostic Questionnaire (CDQ), COPD Assessment in Primary Care To Identify Undiagnosed Respiratory Disease and Exacerbation Risk Questionnaire (CAPTURE), symptom-based questionnaire, COPD Screening Questionnaire (COPD-SQ)), microspirometer and peak flow. Each participant will complete all of these tests in one assessment. The primary analysis will compare the performance of a screening questionnaire with a handheld device. Secondary analyses will include the comparative performance of each index test, as well as a comparison of strategies where we use a screening questionnaire and a handheld device. Approximately 2000 participants will be recruited over 9 to 12 months.Ethics and disseminationThe study has been approved by Peking University Hospital and University of Birmingham. All study participants will provide written informed consent. Study results will be published in appropriate journal and presented at national and international conferences, as well as relevant social media and various community/stakeholder engagement activities.Trial registration numberISRCTN13357135.

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“…Alternatively, symptom‐based questionnaires have been developed and implemented. A COPD questionnaire developed by the International Primary Care Airway Group (IPAG) was validated in many countries, including Japan . However, its diagnostic accuracy is considered to be insufficient due to low discrimination, relatively low specificity and low positive predictive values, which has been confirmed in a meta‐analysis …”

Section: Introductionmentioning

confidence: 99%

Handheld flow meter improves COPD detectability regardless of using a conventional questionnaire: A split‐sample validation study

et al. 2019

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Background and objective Improved detectability of chronic obstructive pulmonary disease (COPD) using a handheld flow meter (HFM) with symptom‐based questionnaires has not been sufficiently evaluated. This study aimed to identify the benefit of using an HFM in COPD screening. Methods A total of 2008 participants, who were ≥ 40 years of age, from Isumi City, Japan, were recruited. We developed two novel point systems for detecting COPD, one incorporated score of HFM alone (sHFM) and the other incorporated the score of International Primary Care Airway Group questionnaire (IPAG) and HFM (sIPAG + HFM). Validation using random sample allocation (split‐sample validation) was carried out to assess the predictive performance of these models. Results Participants were assigned to a data set for model creation (n = 1007) or a data set for model assessment (n = 1001) to perform split‐sample validation. Decision curve analysis showed that the net benefits of sHFM and sIPAG + HFM were higher than that of the IPAG score (sIPAG) and specificity of the former two were also significantly higher than that of sIPAG. However, the curves of sHFM and sIPAG + HFM were crossing and practically the same with no significant difference in sensitivity and specificity. Conclusion This study confirms that HFM is significantly advantageous in detecting COPD despite the use of a conventional questionnaire.

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Do symptom-based questions help screen COPD among Chinese populations?

Cited by 7 publications

References 32 publications

Accuracy and cost-effectiveness of different screening strategies for identifying undiagnosed COPD among primary care patients (≥40 years) in China: a cross-sectional screening test accuracy study: findings from the Breathe Well group

Accuracy and cost-effectiveness of different screening strategies for identifying undiagnosed COPD among primary care patients (≥40 years) in China: a cross-sectional screening test accuracy study: findings from the Breathe Well group

Study to evaluate the effectiveness and cost-effectiveness of different screening strategies for identifying undiagnosed COPD among residents (≥40 years) in four cities in China: protocol for a multicentre cross-sectional study on behalf of the Breathe Well group

Handheld flow meter improves COPD detectability regardless of using a conventional questionnaire: A split‐sample validation study

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