1. LATE-BREAKING ABSTRACT: A novel approach for identifying patients with undiagnosed clinically-significant COPD
- Author
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Nancy Kline Leidy, Catherine A. Meldrum, David M. Mannino, Fernando J. Martinez, Elizabeth D. Bacci, Russell P. Bowler, Barry J. Make, Byron Thomashow, Julia F. Houfek, R. Graham Barr, Stephen I. Rennard, Barbara P. Yawn, MeiLan K. Han, John W. Walsh, and Karen G. Malley
- Subjects
Spirometry ,medicine.medical_specialty ,COPD ,medicine.diagnostic_test ,business.industry ,Primary care ,respiratory system ,Diagnostic evaluation ,medicine.disease ,respiratory tract diseases ,Internal medicine ,Breathing ,Medicine ,Sputum ,medicine.symptom ,business ,Lung function ,Case identification - Abstract
Background: COPD is underdiagnosed, often uncovered during exacerbations or after significant loss of lung function. We are developing a new method (simple questionnaire + peak expiratory flow [PEF]) for identifying patients needing spirometric evaluation for clinically significant COPD (FEV1 Purpose: This study used random forests (RF) to identify the best, smallest set of questions (with and without PEF) capable of case identification. Methods: Prospective, cross-sectional, multi-site, case-control study. Subjects: ≥40 years from US pulmonary and primary care clinics. Cases (clinically significant COPD): ≥1 AECOPD past 12 months or FEV1 60% pred) and AECOPD-free ≥12 months or no COPD. Subjects completed questionnaires, PEF, spirometry (if not on record). Results: N=346; 186 Cases (184 with PEF), 160 Controls. Mean (SD) age=62.7 (10.1) years; 55% female; 86% white; 41% ≤high school; 16% never smoked. Cases: mean (SD) FEV1% pred=42.5(14.2); Controls=82.5(15.7). RF case-control sensitivity/specificity estimates for the final 5-item questionnaire: 83.5/69.7; questionnaire followed by score-driven use of PEF: 90.2/78.8%. Case-no COPD with score-driven PEF: 90.2/92.0. Questions ask about exposure, breathing, tire easily, and acute respiratory illness, and do not ask about smoking, cough, or sputum. Conclusions: These 5 questions + selective use of PEF may be an effective and efficient approach for identifying patients needing diagnostic evaluation for COPD.
- Published
- 2015