[Pack-years threshold and HAS self-questionnaire for COPD early diagnosis].

Area of Science:

• Pulmonology
• Primary Care Screening
• Epidemiology

Background:

• The French Haute Autorité de santé (HAS) developed a patient self-questionnaire for chronic obstructive pulmonary disease (COPD) screening in primary care.
• The current HAS questionnaire includes smoking status but lacks a pack-year (PY) threshold, potentially limiting its precision in identifying at-risk individuals.
• Optimizing targeted screening is crucial for early detection and management of COPD in primary care settings.

Purpose of the Study:

• To evaluate the positive predictive value (PPV) of the existing HAS self-questionnaire for COPD screening.
• To compare the PPV of the HAS questionnaire with and without the addition of a pack-year (PY) smoking threshold.
• To determine if incorporating a PY threshold improves the targeting of patients at risk for COPD.

Main Methods:

• A prospective pilot study was conducted in a multi-professional health center.
• Participants included current or former smokers without a diagnosed COPD.
• Patients were assessed using the HAS self-questionnaire and a defined PY smoking threshold; spirometry confirmed COPD diagnosis.

Main Results:

• Thirty-five patients were included; all met the PY threshold criterion.
• The HAS questionnaire yielded a positive result for 62.9% (22/35) of participants.
• Spirometry confirmed COPD in 51% (18/35) of participants; the PPV for HAS alone was 0.41, and for HAS + PY threshold was 0.51 (P=0.3692).

Conclusions:

• The addition of a pack-year (PY) threshold to the HAS self-questionnaire shows a trend towards improved positive predictive value for COPD screening.
• Incorporating a PY threshold may enhance the ability to better target populations at higher risk of developing COPD in primary care.
• Further research with larger cohorts is warranted to confirm the clinical utility of the modified HAS questionnaire.