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COPD: David B. Price, David G. Tinkelman, Robert J. Nordyke, Sharon Isonaka, R. J. Halbert for the COPD Questionnaire Study Group Scoring System and Clinical Application of COPD Diagnostic Questionnaires Chest 2006; 129: 1531-1539 [Abstract] [Full text] [PDF]

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COPD questionnaires: A need in primary health care

Markos Minas, Konstantinos I Gourgoulianis   (11 July 2006)

COPD questionnaires: A need in primary health care 11 July 2006
Markos Minas , Konstantinos I Gourgoulianis Send letter to journal: Re: COPD questionnaires: A need in primary health care markosminas{at}hotmail.com Markos Minas, et al.	Dear Editor, In a recent article entitled “Scoring system and clinical application of COPD questionnaires”[1], Price et al describe the effort of making a scoring system for two questionnaires concerning the diagnosis of COPD and the differential diagnosis between COPD and asthma. In Greece, COPD is underdiagnosed or diagnosed in last stages when severe obstruction has been occurred[2,3]. As a result, we have foreseen the need of creating a questionnaire for early diagnosis of COPD in primary heath care. For the creation of the questionnaire existing models[4,5] have been used as well as risk factors referred in the GOLD for COPD[6] were taken into account. As a result we have used questions that are used for the diagnosis of COPD. The questions included are: Patient’s Age, Childhood infections, Exposure to occupational dusts, Smoking in Packs per day * Years (PYS), Clinical symptoms, Symptom’s outbreak age, Physical chest examination and Allergies. The next stage was to adapt a scoring system at these questions in order to find the cut off point for the diagnosis of COPD. The finally scale has range from 0 to 40 and the cut off point calculated is at 15 points. The questionnaire was tested at a sample of 447 subjects, where COPD was diagnosed at 85 subjects (19%). At this cut off point the sensitivity and specificity are 92.9% and 81.5% respectively. The PPV and NPV are 54.1% and 98% respectively. When the cut off point moved at 19 points, sensitivity and specificity were 81.2% and 90.3% respectively whereas PPV and NPV were 66.3%and 95.3% respectively. In conclusion, we believe that a questionnaire for the diagnosis of COPD should be used in primary care so that COPD patients get diagnosed at early stages. However such questionnaires of course cannot replace spirometry which is the method for putting COPD diagnosis. However we estimate that such questionnaires can be used as screening tools where spirometry is not available and raise the suspicion for the existence of COPD so that the patient referred to a pulmonologist. References 1. Price DB, Tinkelman DG, Nordyke RJ et al. Scoring system and clinical application of COPD questionnaires. Chest 2006;129:1531-9. 2. Gourgoulianis KI, Katikos P, Moraitis M et al. Chronic bronchitis in rural and industrial areas. Ann Agric Environ Med 2000;7:29-31. 3. Minas M, Dimitropoulos K, Pastaka Ch et al. Global Initiative for chronic obstructive lung disease for chronic obstructive pulmonary disease: GOLD opportunity for lung disorders. Prev Med 2005;40:274-77. 4. Freeman D, Nordyke RJ, Isonaka S et al. Questions for COPD diagnostic screening in a primary care setting. Respiratory medicine 2005;99:1311-1318. 5. Price DB, Tinkelman DG, Halbert RJ et al. Symptom-based questionnaire for identifying COPD in smokers. Respiration 2006;73:285-95. 6. Global Initiative for Chronic Obstructive Lung Disease. Global strategy for the management, and prevention of chronic obstructive pulmonary disease, updated 2004. Available at: www.goldcopd.com Accessed November 8, 2005.