Development and initial validation of a self-scored COPD Population Screener Questionnaire (COPD-PS)

Fernando J Martinez, Anastasia E Raczek, Frederic D Seifer, Craig S Conoscenti, Tammy G Curtice, Thomas D'Eletto, Claudia Cote, Clare Hawkins, Amy L Phillips, COPD-PS Clinician Working Group, Roderick Bartlett, James Connor, Claudia Cote, Clare Hawkins, Mary Issac, Fernando J Martinez, Phillip Menashe, Anna W Parkman, Michael A Russoniello, Frederic Seifer, Fernando J Martinez, Anastasia E Raczek, Frederic D Seifer, Craig S Conoscenti, Tammy G Curtice, Thomas D'Eletto, Claudia Cote, Clare Hawkins, Amy L Phillips, COPD-PS Clinician Working Group, Roderick Bartlett, James Connor, Claudia Cote, Clare Hawkins, Mary Issac, Fernando J Martinez, Phillip Menashe, Anna W Parkman, Michael A Russoniello, Frederic Seifer

Abstract

COPD has a profound impact on daily life, yet remains underdiagnosed and undertreated. We set out to develop a brief, reliable, self-scored questionnaire to identify individuals likely to have COPD. COPD-PS development began with a list of concepts identified for inclusion using expert opinion from a clinician working group comprised of pulmonologists (n = 5) and primary care clinicians (n = 5). A national survey of 697 patients was conducted at 12 practitioner sites. Logistic regression identified items discriminating between patients with and without fixed airflow obstruction (AO, postbronchodilator FEV(1)/FVC < 70%). ROC analyses evaluated screening accuracy, compared scoring options, and assessed concurrent validity. Convergent and discriminant validity were assessed via COPD-PS and SF-12v2 score correlations. For known-groups validation, COPD-PS differences between clinical groups were tested. Test-retest reliability was evaluated in a 20% sample. Of 697 patients surveyed, 295 patients met expert review criteria for spirometry performance; 38% of these (n = 113) had results indicating AO. Five items positively predicted AO (p < 0.0001): breathlessness, productive cough, activity limitation, smoking history, and age. COPD-PS scores accurately classified AO status (area under ROC curve = 0.81) and reliable (r = 0.91). Patients with spirometry indicative of AO scored significantly higher (6.8, SD = 1.9; p< 0.0001) than patients without AO (4.0, SD = 2.3). Higher scores were associated with more severe AO, bronchodilator use, and overnight hospitalization for breathing problems. With the prevalence of COPD in the studied cohort, a score on the COPD-PS of greater than five was associated with a positive predictive value of 56.8% and negative predictive value of 86.4%. The COPD-PS accurately classified physician-reported COPD (AUC = 0.89). The COPD-PS is a brief, accurate questionnaire that can identify individuals likely to have COPD.

Figures

Figure 1
Figure 1
ROC curve: COPD-PS™ score and AO diagnosis. ROC: receiver operating characteristic; AUC: area under the curve; COPD-PS: COPD Population Screener; COPD: chronic obstructive pulmonary disease.

References

    1. Mannino D, Homa D, Akinbami L, Ford E, Redd S. Chronic obstructive pulmonary disease surveillance—United States, 1971–2000. Respir Care. 2002;47:1148–1149.
    1. Global Initiative for Chronic Obstructive Lung Disease (GOLD) Global Strategy for the Diagnosis, Management, and Prevention of COPD. 2006. Available at (accessed December 2006)
    1. Barnes P, Kleinert S. COPD—a neglected disease. Lancet. 2004;364:564–565.
    1. Varkey B. Chronic obstructive pulmonary disease: from nihilism to tempered optimism. Curr Opin Pulm Med. 2005;11:113.
    1. Caramori G, Bettoncelli G, Tosatto R, Arpinelli F, Visona G, Invernizzi G, Novelletto B, Papi A, Adcock I, Ciaccia A. Underuse of spirometry by general practitioners for the diagnonsis of COPD in Italy. Monaldi Arch Chest Dis. 2005;63:6–12.
    1. Ferguson G, Enright P, Buist A, Higgins M. Office spirometry for lung health assessment in adults: a consensus statement from the National Lung Health Education Program. Chest. 2000;117:1146–1161.
    1. Lee T, Bartle B, Weiss K. Spirometry use in clinical practice following diagnosis of COPD. Chest. 2006;129:1509–1515.
    1. Bolton C, Ionescu A, Edwards P, Faulkner T, Edwards S, Shale D. Attaining a correct diagnosis of COPD in general practice. Respir Med. 2005;99:493–500.
    1. Kaminsky D, Marcy T, Bachand M, Irvin C. Knowledge and use of office spirometry for the detection of chronic obstructive pulmonary disease by primary care physicians. Respir Care. 2005;50:1639–1648.
    1. Tinkelman D, Price D, Nordyke R, Halbert R. Misdiagnosis of COPD and asthma in primary care patients 40 years of age and over. J Asthma. 2006;43:75–80.
    1. de Marco R, Accordini S, Cerveri I, Corsico A, Sunyer J, Neukirch F, Kunzli N, Leynaert B, Janson C, Gislason T, Vermeire P, Svanes C, Anto J, Burney P, European Community Respiratory Health Survey Study Group An international survey of chronic obstructive pulmonary disease in young adults according to GOLD stages. Thorax. 2004;59:120–125.
    1. Calverley P, Nordyke R, Halbert R, Isonaka S, Nonikov D. Development of a population-based screening questionnaire for COPD. COPD. 2005;2(2):225–232.
    1. Ware J, Jr, Kosinski M, Turner-Bowker D, Gandek B. How to score version 2 of the SF-12@ Health Survey (With a supplement documenting version 1) Lincoln, RI: Quality Metric Incorporated; 2002.
    1. American Thoracic Society. Standardization of spirometry. Am J Respir Crit Care Med. 1995;152:1107–1136. . 1994 Update.
    1. American Thoracic Society. Lung function testing: selection of reference values and interpretative strategies. Am Rev Respir Dis. 1991;144:1202–1218.
    1. Cohen J. Statistical Power Analysis for the Behavioral Sciences. 2nd Ed. Hillsdale, NJ: Lawrence Erlbaum Associates, Inc.; 1998.
    1. Flahault A, Cadilhac M, Thomas G. Sample size calculation should be performed for design accuracy in diagnostic test studies. J Clin Epidemiol. 2005;58(8):859–862.
    1. Obuchowski N. Sample size tables for receiver operating characteristic studies. Am J Roentgenol. 2000;175(3):603–608.
    1. Morris J, Koski A, Johnson L. Spirometric standards for healthy nonsmoking adults. Am Rev Respir Dis. 1971;103:57–67.
    1. Dillman D. Mail and Internet Surveys: The Tailored Design Method. 2nd E. New York: John Wiley & Sons, Inc.; 1999.
    1. Hanley J, McNeil B. A method of comparing the areas under receiving operating characteristic curves derived from the same set of cases. Radiology. 1983;148:839–843.
    1. Shrout P. Measurement reliability and agreement in psychiatry. Stat Meth Med Res. 1998;7(3):301–317.
    1. Shrout P, Fleiss J. Intraclass correlations: uses in assessing rater reliability. Psychol Bull. 1979;86:420–427.
    1. Nunnally J. Psychometric Theory. 2nd Ed. New York, NY: McGraw-Hill; 1978.
    1. Gilpin E, White M, White V, Distefan J, Trinidad D, James L, Lee L, Major J, Kealey S, Pierce J. Tobacco control successes in California: a focus on young people, results from the California Tobacco Surveys, 1990–2002. San Diego, La Jolla, CA: University of California; 2004.
    1. Holtby S, Zahnd E, Lordi N, McCain C, Chia J, Kurata J. Health of California's adults, adolescents, and children: findings from the CHIS 2003 and 2001. Los Angeles, CA: UCLA Center for Health Policy Research; 2006.
    1. Hughes E, McCracken M, Roberts H, Mokdad A, Valluru B, Goodson R, Dunn E, Elam-Evans L, Giles W, Jiles R. Surveillance for certain health behaviors among states and selected local areas–Behavioral Risk Factor Surveillance System, United States, 2004. MMWR Morb Mortal Wkly Rep. 2006;55(SS–07)
    1. Lethbridge-Cejku M, Rose D, Vickerie J. Summary of health statistics for U.S. Adults. National Health Interview Survey, 2004. National Center for Health Statistics. Vital Health Stat. 2006;10(228)
    1. Buffels J, Degryse J, Heyrman J, Decramer M, DIDASCO Study Office spirometry significantly improves early detection of COPD in general practice. The DIDASCO Study. Chest. 2004;125:1394–1399.
    1. Mullerova H, Wedzicha J, Soriano J, Vestbo J. Validation of a chronic obstructive pulmonary disease screening questionnaire for population surveys. Respir Med. 2004;98:78–83.
    1. Barr R, Herbstman J, Speizer F, Camargo C., Jr Validation of a self-reported chronic obstructive pulmonary disease in a cohort study of nurses. Am J Epimediol. 2002;155:965–971.
    1. Price D, Tinkelman D, Nordyke R, Isonaka S, Halbert R. Scoring system and clinical application of COPD diagnosis questionnaire. Chest. 2006;129:1531–1539.
    1. Freeman D, Nordyke R, Isonaka S, Nonikov D, Maroni J, Price D, Halbert R. Questions for COPD diagnostic screening in a primary care setting. Respir Med. 2005;99:1311–1318.
    1. van Schayck C, Loozen J, Wagena E, Akkermans R, Wesseling G. Detecting patients at high risk of developing chronic obstructive pulmonary disease in a general practice: cross sectional case finding study. BMJ. 2002;324:1370.
    1. Van Schayck C, Halbert R, Nordyke R, 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.
    1. Price D, Tinkelman D, Halbert R, Nordyke R, Isonaka S, Nonikov D, Juniper E, Freeman D, Hause T, Levy M, Ostrem A, Van der Molen T, van Schayck C. Symptom-based questionnaire for identifying chronic obstructive pulmonary disease in smokers. Respiration. 2006;73:285–295.
    1. Eaton T, Withy S, Garrett J, Mercer J, Whitlock R, Rea H. Spirometry in primary care practice. The importance of quality assurance and the impact of spirometry workshops. Chest. 2006;116:416–423.
    1. Schermer T, Jacobs J, Chavannes N, Hartman J, Folgering H, Bottema B, Van Weel C. Validity of spirometric testing in a general practice population of patients with chronic obstructive pulmonary disease (COPD) Thorax. 2003;58:861–866.

Source: PubMed

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