Background: Symptom-based questionnaires may enhance chronic obstructive pulmonary disease (COPD) screening in primary care. Objectives: We prospectively tested questions to help identify COPD among smokers without prior history of lung disease. Methods: Subjects were recruited via random mailing to primary care practices in Aberdeen, UK, and Denver, Colo., USA. Current and former smokers aged 40 or older with no prior respiratory diagnosis and no respiratory medications in the past year were enrolled. Participants answered questions covering demographics and symptoms and then underwent spirometry with reversibility testing. A study diagnosis of COPD was defined as fixed airway obstruction as measured by postbronchodilator FEV1/FVC <0.70. We examined the ability of individual questions in a multivariate framework to correctly discriminate between persons with and without COPD. Results: 818 subjects completed all investigations and proceeded to analysis. The list of 54 questions yielded 52 items for analysis, which was reduced to 17 items for entry into multivariate regression. Eight items had significant relationships with the study diagnosis of COPD, including age, pack-years, body mass index, weather-affected cough, phlegm without a cold, morning phlegm, wheeze frequency, and history of any allergies. Individual items yielded odds ratios ranging from 0.23 to 12. This questionnaire demonstrated a sensitivity of 80.4 and specificity of 72.0. Conclusions: A simple patient self-administered questionnaire can be used to identify patients with a high likelihood of having COPD, for whom spirometric testing is particularly important. Implementation of this questionnaire could enhance the efficiency and diagnostic accuracy of current screening efforts.

Keywords:
Chronic obstructive pulmonary disease, Diagnosis, Primary care, Questionnaires, Spirometry, Validation studies
1.
Global Initiative for Chronic Obstructive Lung Disease: Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease. National Institutes of Health, National Heart, Lung, and Blood Institute; April 2001 (updated 2003). URL: www.goldcopd.com (accessed 13 Aug 2004).
2.
Petty TL: Definitions, causes, course, and prognosis of chronic obstructive pulmonary disease. Respir Care Clin N Am 1998;4:345–358, vii.
3.
van den Boom G, Rutten-van Molken MP, Tirimanna PR, van Schayck CP, Folgering H, van Weel C: Association between health-related quality of life and consultation for respiratory symptoms: results from the DIMCA programme. Eur Respir J 1998;11:67–72.
4.
den Otter JJ, van Dijk B, van Schayck CP, Molema J, van Weel C: How to avoid underdiagnosed asthma/chronic obstructive pulmonary disease? J Asthma 1998;35:381–387.
5.
National Lung Health Education Program. Strategies in preserving lung health and preventing COPD and associated diseases. Chest 1998;113(2 suppl):123S–163S.
6.
Hurd S: The impact of COPD on lung health worldwide: epidemiology and incidence. Chest 2000;117(2 suppl):1S–4S.
7.
Ferguson GT, Enright PL, Buist AS, Higgins MW: Office spirometry for lung health assessment in adults: a consensus statement from the National Lung Health Education Program. Chest 2000;117:1146–1161.
8.
Iqbal A, Schloss S, George D, Isonaka S: Worldwide guidelines for chronic obstructive pulmonary disease: a comparison of diagnosis and treatment recommendations. Respirology 2002;7:233–239.
9.
van Weel C: Underdiagnosis of asthma and COPD: is the general practitioner to blame? Monaldi Arch Chest Dis 2002;57:65–68.
10.
Korsten AMMH, van Schayck CP: New International Primary Care Airways Guidelines (IPAG). Rev Fr Allergol Immunol Clin 2003;43:246–248.
11.
Anthonisen NR, Dik N, Manfreda J, Roos LL: Spirometry and obstructive lung disease in Manitoba. Can Respir J 2001;8:421–426.
12.
Tirimanna PR, van Schayck CP, den Otter JJ, van Weel C, van Herwaarden CL, van den Boom G, van Grunsven PM, van den Bosch WJ: Prevalence of asthma and COPD in general practice in 1992: has it changed since 1977? Br J Gen Pract 1996;46:277–281.
13.
Kornmann O, Beeh KM, Beier J, Geis UP, Ksoll M, Buhl R: Global Initiative for Obstructive Lung Disease. Newly diagnosed chronic obstructive pulmonary disease. Clinical features and distribution of the novel stages of the Global Initiative for Obstructive Lung Disease. Respiration 2003;70:67–75.
14.
van Schayck CP, Loozen JM, Wagena E, Akkermans RP, Wesseling GJ: Detecting patients at a high risk of developing chronic obstructive pulmonary disease in general practice: cross sectional case finding study. BMJ 2002;324:1370.
15.
Calverley PMA, Nordyke RJ, Halbert RJ, Isonaka S, Nonikov D: Development of a population-based screening questionnaire for COPD. J COPD 2005;2:225–232.
16.
Müllerová H, Wedzicha J, Soriano JB, Vestbo J: Validation of a chronic obstructive pulmonary disease screening questionnaire for population surveys. Respir Med 2004;98:78–83.
17.
van Schayck CP, Halbert RJ, Nordyke RJ, Isonaka S, Maroni J, Nonikov D: Comparison of existing symptom-based questionnaires for identifying COPD in the general practice setting. Respirology 2005;10:323–333.
18.
Kida K, Wakabayashi R, Mizuuchi T, Katsura H, Yamada K, Motegi T, Nishimura N, Omata M, Goto R, Mizuno S: Pre-screening test for chronic obstructive pulmonary disease (COPD) using an 11-item questionnaire for elderly subjects (abstract P1663). 12th Annual Congress of the European Respiratory Society, Stockholm, September 14–18, 2002.
19.
Freeman D, Nordyke RJ, Isonaka S, Nonikov DV, Maroni JM, Price D, Halbert RJ: Questions for COPD diagnostic screening in a primary care setting. Respir Med 2005;99:1311–1318.
20.
Levy M, Halbert RJ, Isonaka S, Justus C: What factors identify COPD in general practice? A Delphi approach (abstract). 13th Annual Congress of the European Respiratory Society, Vienna, September 27 to October 1, 2003.
21.
Juniper EF, Guyatt GH, Jaeschke R: How to develop and validate a new quality of life instrument; in Spilker B (ed): Quality of Life and Pharmacoeconomics in Clinical Trials, ed 2. New York, Raven, 1995, pp 49–56.
22.
American Thoracic Society: Standardization of spirometry, 1994 update. Am J Respir Crit Care Med 1995;152:1107–1136.
23.
Global Initiative for Asthma: National Heart, Lung, and Blood Institute/World Health Organization Workshop Report: Global Strategy for Asthma Management and Prevention, updated April 2002. Bethesda, National Institutes of Health, NIH Publication No. 02-3659. URL: www.ginasthma.com (accessed 13 Aug 2004).
24.
Cox DR: A note on data-splitting for the evaluation of significance levels. Biometrika 1975;62:441–444.
25.
Kim JO, Mueller CW: Factor Analysis: Statistical Methods and Practical Issues. Sage University Paper Series on Quantitative Applications in the Social Sciences, No. 07-14. Beverly Hills, Sage; 1978.
26.
Menard S: Applied Logistic Regression Analysis. Sage University Paper Series on Quantitative Applications in the Social Sciences, No: 07-106. Beverly Hills, Sage; 2002.
27.
StataCorp: STATA statistical software: release 7.0. College Station, Stata Press, 2001.
28.
Fletcher C, Peto R: The natural history of chronic airflow obstruction. Br Med J 1977;i:1645–1648.
29.
Godtfredsen NS, Vestbo J, Osler M, Prescott E: Risk of hospital admission for COPD following smoking cessation and reduction: a Danish population study. Thorax 2002;57:967–972.
30.
Fagerstrom KO: Can reduced smoking be a way for smokers not interested in quitting to actually quit? Respiration 2005;72:216–220.
31.
National Institute for Clinical Excellence: Chronic obstructive pulmonary disease: national clinical guideline on management of chronic obstructive pulmonary disease in adults in primary and secondary care. Appendix B: The cost effectiveness of opportunistic case finding in primary care. Thorax 2004;59(suppl 1):i175–i190.
32.
Calverley PMA, Walker P: Chronic obstructive pulmonary disease. Lancet 2003;362:1053–1061.
33.
Celli BR, Cote CG, Marin JM, Casanova C, Montes de Oca M, Mendez RA, Pinto Plata V, Cabral HJ: The body-mass index, airflow obstruction, dyspnea, and exercise capacity index in chronic obstructive pulmonary disease. N Engl J Med 2004;350:1005–1012.
34.
Chinn S, Jarvis D, Burney P: Relation of bronchial responsiveness to body mass index in the ECRHS. Thorax 2002;57:1028–1033.
35.
Lebowitz MD, Burrows B: Comparison of questionnaires: the BMRC and NHLI respiratory questionnaires and a new self-completion questionnaire. Am Rev Respir Dis 1976;113:627–635.
36.
Hardie JA, Buist AS, Vollmer WM, Ellingsen I, Bakke PS, Mørkve O: Risk of over-diagnosis of COPD in asymptomatic elderly never-smokers. Eur Respir J 2002;20:1117–1122.
© 2006 S. Karger AG, Basel
2006
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.