COPD Diagnostic Questionnaire (CDQ) for selecting at-risk patients for spirometry: a cross-sectional study in Australian general practice
In: NPJ Primary Care Respiratory Medicine npj Primary Care Respiratory Medicine, 24:14024. Springer Nature; (2014)
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Zugriff:
Using the COPD Diagnostic Questionnaire (CDQ) as a selection tool for spirometry could potentially improve the efficiency and accuracy of chronic obstructive pulmonary disease (COPD) diagnosis in at-risk patients. To identify an optimal single cut point for the CDQ that divides primary care patients into low or high likelihood of COPD, with the latter group undergoing spirometry. Former or current smokers aged 40–85 years with no prior COPD diagnosis were invited to a case-finding appointment with the practice nurse at various general practices in Sydney, Australia. The CDQ was collected and pre- and post-bronchodilator spirometry was performed. Cases with complete CDQ data and spirometry meeting quality standards were analysed (1,054 out of 1,631 patients). CDQ cut points were selected from a receiver operating characteristic (ROC) curve. The area under the ROC curve was 0.713. A cut point of 19.5 had the optimal combination of sensitivity (63%) and specificity (70%) with two-thirds below this cut point. A cut point of 14.5 corresponded to a sensitivity of 91%, specificity of 35% and negative predictive value of 96%, and 31% of patients below this cut point. The CDQ can be used to select patients at risk of COPD for spirometry using one cut point. We consider two possible cut points. The 19.5 cut point excludes a higher proportion of patients from undergoing spirometry with the trade-off of more false negatives. The 14.5 cut point has a high sensitivity and negative predictive value, includes more potential COPD cases but has a higher rate of false positives. A diagnostic questionnaire can help clinicians determine which patients should be tested for chronic obstructive pulmonary disease (COPD). In COPD, a lung disease often associated with smoking, the airways become obstructed and patients have difficulty breathing. Clinicians can test for COPD using spirometry, which measures airflow into and out of patients' lungs but testing all patients is time-consuming. A diagnostic questionnaire (CDQ) is available but the ideal score for recommending spirometry was unclear. Anthony Stanley of the University of New South Wales in Australia and colleagues compared the CDQ scores and spirometry results of 1054 patients. They recommend two possible scores: using a score of 19.5 would minimise use of spirometry while detecting most cases of COPD, whereas using a score of 14.5 would detect more COPD cases but would have a higher false-positive rate.
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COPD Diagnostic Questionnaire (CDQ) for selecting at-risk patients for spirometry: a cross-sectional study in Australian general practice
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Autor/in / Beteiligte Person: | Crockett, Alan J. ; Hasan, Iqbal ; Onno C. P. van Schayck ; Zwar, Nicholas ; Stanley, Anthony ; Stanley, Anthony J ; Crockett, Alan J ; Van Schayck, Onno CP ; Zwar, Nicholas A ; Medicine, Family ; RS: CAPHRI School for Public Health and Primary Care ; RS: CAPHRI - Asthma and, COPD |
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Quelle: | NPJ Primary Care Respiratory Medicine npj Primary Care Respiratory Medicine, 24:14024. Springer Nature; (2014) |
Veröffentlichung: | United Kingdom : Nature Publishing Group, 2014 |
Medientyp: | unknown |
ISSN: | 2055-1010 (print) |
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