Validation of the COPD Diagnostic Questionnaire in an Australian general practice cohort: a cross-sectional study

Anthony J Stanley, Iqbal Hasan, Alan J Crockett, Onno C P van Schayck, Nicholas A Zwar, Anthony J Stanley, Iqbal Hasan, Alan J Crockett, Onno C P van Schayck, Nicholas A Zwar

Abstract

Background: The gold standard for the diagnosis of chronic obstructive pulmonary disease (COPD) is spirometry, but there are barriers to its use in primary care.

Aims: To externally validate the COPD Diagnostic Questionnaire (CDQ) as a diagnostic tool in patients at increased risk in Australian general practice and to compare its performance with other CDQ validation studies.

Methods: Patients were recruited from 36 general practices in Sydney, Australia. Former or current smokers aged 40-85 years with no prior COPD diagnosis were invited to a case-finding appointment with the practice nurse. The CDQ was collected and pre- and postbronchodilator spirometry was performed. Cases for whom complete CDQ data were present and the spirometry met quality standards were analysed.

Results: Of 1,631 patients who attended case-finding recruitment, 1,054 (65%) could be analysed. Spirometry showed 13% had COPD. The ability of the CDQ to discriminate between patients with and without COPD was fair, represented by the area under the receiver operating characteristic curve of 0.713. With a CDQ cut-off point value of 16.5 the sensitivity was 80% and specificity 47% and, at a cut-off point value of 19.5, the sensitivity was 63% and specificity 70%.

Conclusions: The CDQ did not discriminate between patients with and without COPD accurately enough to use as a diagnostic tool in patients at increased risk of COPD in Australian general practice. Further research is needed on the value of the CDQ as a tool for selecting patients for spirometry.

Conflict of interest statement

The authors declare they have no conflicts of interest in relation to this article. OCPvS is an Assistant Editor and AJC is on the International Editorial Board of PCRJ, but they were not involved in the editorial review of or the decision to publish this article.

Figures

Figure 1. Flow chart showing study numbers…
Figure 1. Flow chart showing study numbers and reasons for exclusion from statistical data analysis. Percentages in brackets represent the proportion of the initial 1,631 subjects. CDQ= COPD Diagnostic Questionnaire
Figure 2. Receiver operating characteristic (ROC) curve…
Figure 2. Receiver operating characteristic (ROC) curve for the CDQ score compared with chronic obstructive pulmonary disease diagnosis. Area under ROC curve (ROCAUC) was 0.713. A ROCAUC of 1.0 would have the optimal operating point indicated by the star. A ROCAUC of 0.5 is indicated by the solid diagonal line. CDQ= COPD Diagnostic Questionnaire

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Source: PubMed

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