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Meta-Analysis
. 2021 May 25;30(160):200350.
doi: 10.1183/16000617.0350-2020. Print 2021 Jun 30.

Performance of alternative COPD case-finding tools: a systematic review and meta-analysis

Elena Schnieders  1 , Elyesa Ünal  2 , Volker Winkler  2 , Peter Dambach  2 , Valérie R Louis  2 , Olaf Horstick  2 , Florian Neuhann  2   3 , Andreas Deckert  2
Affiliations
Meta-Analysis

Performance of alternative COPD case-finding tools: a systematic review and meta-analysis

Elena Schnieders et al. Eur Respir Rev. .

Abstract

Rationale: Guidelines recommend pre-/post-bronchodilator spirometry for diagnosing COPD, but resource constraints limit the availability of spirometry in primary care in low- and middle-income countries. Although spirometry is the diagnostic gold standard, we shall assess alternative tools for settings without spirometry.

Methods: A systematic literature review and meta-analysis was conducted, utilising Cochrane, CINAHL, Google Scholar, PubMed and Web of Science (search cut-off was May 01, 2020). Published studies comparing the accuracy of diagnostic tools for COPD with post-bronchodilator spirometry were considered. Studies without sensitivity/specificity data, without a separate validation sample and outside of primary care were excluded. Sensitivity, specificity and area under the curve (AUC) were assessed.

Results: Of 7578 studies, 24 were included (14 635 participants). Hand devices yielded a larger AUC than questionnaires. The meta-analysis included 17 studies and the overall AUC of micro-spirometers (0.84, 95% CI 0.80-0.89) was larger when compared to the COPD population screener (COPD-PS) questionnaire (0.77, 95% CI 0.63-0.85) and the COPD diagnostic questionnaire (CDQ) (0.72, 95% CI 0.64-0.78). However, only the difference between micro-spirometers and the CDQ was significant.

Conclusions: The CDQ and the COPD-PS questionnaire were approximately equally accurate tools. Questionnaires ensured testing of symptomatic patients, but micro-spirometers were more accurate. A combination could increase accuracy but was not evaluated in the meta-analysis.

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Conflict of interest statement

Conflict of interest: E. Schnieders reports receiving a scholarship from the Heidelberg Graduate School of Global Health, which is funded by the Else-Kröner-Fresenius Stiftung. Conflict of interest: E. Ünal has nothing to disclose. Conflict of interest: V. Winkler has nothing to disclose. Conflict of interest: P. Dambach has nothing to disclose. Conflict of interest: V.R. Louis has nothing to disclose. Conflict of interest: O. Horstick has nothing to disclose. Conflict of interest: F. Neuhann has nothing to disclose. Conflict of interest: A. Deckert has nothing to disclose.

Figures

FIGURE 1
FIGURE 1
Systematic review: forest plot of area under the curve (AUC) values with 95% confidence intervals (CIs) of hand devices (mainly the micro-spirometers COPD-6 and Piko-6), questionnaires, or both hand devices and questionnaires. The COPD-6 score was based on micro-spirometry results. PEF: peak expiratory flow; CDQ: COPD diagnostic questionnaire; COPD-PS: COPD population screener; VAFOSQ: veterans’ airflow obstruction screening questionnaire; PUMA: PUMA study questionnaire; LFQ: lung function questionnaire; 11-Q: 11-Q COPD screening questionnaire; SCSQ: Salzburg COPD-screening questionnaire; EGARPOC: EGARPOC study questionnaire; RHSQ: respiratory health screening questionnaire.
FIGURE 2
FIGURE 2
Descriptive analysis and meta-analysis: scatterplot of sensitivities and specificities, as well as summary receiver operating characteristic (ROC) curves (including prediction region) for a) the COPD diagnostic questionnaire; b) the COPD population screener questionnaire; and c) micro-spirometers. AUC: area under the curve; CI: confidence interval; NA: not available.
See this image and copyright information in PMC

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