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Multicenter Study
. 2017 Mar 15;195(6):748-756.
doi: 10.1164/rccm.201603-0622OC.

A New Approach for Identifying Patients with Undiagnosed Chronic Obstructive Pulmonary Disease

Fernando J Martinez  1 , David Mannino  2 , Nancy Kline Leidy  3 , Karen G Malley  3 , Elizabeth D Bacci  4 , R Graham Barr  5   6 , Russ P Bowler  7 , MeiLan K Han  8 , Julia F Houfek  9 , Barry Make  7 , Catherine A Meldrum  8 , Stephen Rennard  10   11 , Byron Thomashow  12 , John Walsh  13 , Barbara P Yawn  14 ; High-Risk-COPD Screening Study Group *
Affiliations
Multicenter Study

A New Approach for Identifying Patients with Undiagnosed Chronic Obstructive Pulmonary Disease

Fernando J Martinez et al. Am J Respir Crit Care Med. .

Erratum in

Abstract

Rationale: Chronic obstructive pulmonary disease (COPD) is often unrecognized and untreated.

Objectives: To develop a method for identifying undiagnosed COPD requiring treatment with currently available therapies (FEV1 <60% predicted and/or exacerbation risk).

Methods: We conducted a multisite, cross-sectional, case-control study in U.S. pulmonary and primary care clinics that recruited subjects from primary care settings. Cases were patients with COPD and at least one exacerbation in the past year or FEV1 less than 60% of predicted without exacerbation in the past year. Control subjects were persons with no COPD or with mild COPD (FEV1 ≥60% predicted, no exacerbation in the past year). In random forests analyses, we identified the smallest set of questions plus peak expiratory flow (PEF) with optimal sensitivity (SN) and specificity (SP).

Measurements and main results: PEF and spirometry were recorded in 186 cases and 160 control subjects. The mean (SD) age of the sample population was 62.7 (10.1) years; 55% were female; 86% were white; and 16% had never smoked. The mean FEV1 percent predicted for cases was 42.5% (14.2%); for control subjects, it was 82.5% (15.7%). A five-item questionnaire, CAPTURE (COPD Assessment in Primary Care to Identify Undiagnosed Respiratory Disease and Exacerbation Risk), was used to assess exposure, breathing problems, tiring easily, and acute respiratory illnesses. CAPTURE exhibited an SN of 95.7% and an SP of 44.4% for differentiating cases from all control subjects, and an SN of 95.7% and an SP of 67.8% for differentiating cases from no-COPD control subjects. The PEF (males, <350 L/min; females, <250 L/min) SN and SP were 88.0% and 77.5%, respectively, for differentiating cases from all control subjects, and they were 88.0% and 90.8%, respectively, for distinguishing cases from no-COPD control subjects. The CAPTURE plus PEF exhibited improved SN and SP for all cases versus all control subjects (89.7% and 78.1%, respectively) and for all cases versus no-COPD control subjects (89.7% and 93.1%, respectively).

Conclusions: CAPTURE with PEF can identify patients with COPD who would benefit from currently available therapy and require further diagnostic evaluation. Clinical trial registered with clinicaltrials.gov (NCT01880177).

Keywords: chronic obstructive pulmonary disease; primary care; questionnaire; random forests; screening.

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Figures

Figure 1.
Figure 1.
The CAPTURE questionnaire (Chronic Obstructive Pulmonary Disease Assessment in Primary Care to Identify Undiagnosed Respiratory Disease and Exacerbation Risk).
Figure 2.
Figure 2.
Receiver operating characteristic (ROC) curve and area under the curve statistics for differentiating cases from control subjects using CAPTURE alone, peak expiratory flow (PEF) alone, and PEF + CAPTURE. CAPTURE = Chronic Obstructive Pulmonary Disease Assessment in Primary Care to Identify Undiagnosed Respiratory Disease and Exacerbation Risk.
See this image and copyright information in PMC

Comment in

References

    1. Ford ES, Mannino DM, Wheaton AG, Giles WH, Presley-Cantrell L, Croft JB. Trends in the prevalence of obstructive and restrictive lung function among adults in the United States: findings from the National Health and Nutrition Examination surveys from 1988-1994 to 2007-2010. Chest. 2013;143:1395–1406. - PMC - PubMed
    1. Miravitlles M, Soriano JB, García-Río F, Muñoz L, Duran-Tauleria E, Sanchez G, Sobradillo V, Ancochea J. Prevalence of COPD in Spain: impact of undiagnosed COPD on quality of life and daily life activities. Thorax. 2009;64:863–868. - PubMed
    1. Martinez CH, Mannino DM, Jaimes FA, Curtis JL, Han MK, Hansel NN, Diaz AA. Undiagnosed obstructive lung disease in the United States: associated factors and long-term mortality. Ann Am Thorac Soc. 2015;12:1788–1795. - PMC - PubMed
    1. Labonté LE, Tan WC, Li PZ, Mancino P, Aaron SD, Benedetti A, Chapman KR, Cowie R, FitzGerald JM, Hernandez P, et al. Canadian Respiratory Research Network, CanCOLD Collaborative Research Group. Undiagnosed chronic obstructive pulmonary disease contributes to the burden of health care use: data from the CanCOLD Study. Am J Respir Crit Care Med. 2016;194:285–298. - PubMed
    1. Qaseem A, Snow V, Shekelle P, Sherif K, Wilt TJ, Weinberger S, Owens DK Clinical Efficacy Assessment Subcommittee of the American College of Physicians. Diagnosis and management of stable chronic obstructive pulmonary disease: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2007;147:633–638. - PubMed

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