Performance of alternative COPD case-finding tools: a systematic review and meta-analysis

Area of Science:

• Pulmonary Medicine
• Diagnostic Accuracy
• Health Technology Assessment

Background:

• Spirometry is recommended for COPD diagnosis but often unavailable in low-resource primary care settings.
• Alternative diagnostic tools are needed where spirometry access is limited.
• This study assesses non-spirometry diagnostic methods for COPD.

Purpose of the Study:

• To evaluate the diagnostic accuracy of alternative tools for COPD in settings lacking spirometry.
• To compare the performance of questionnaires and handheld devices against spirometry.
• To identify effective diagnostic strategies for COPD in resource-constrained primary care.

Main Methods:

• Systematic literature review and meta-analysis of studies comparing diagnostic tools for COPD.
• Searched multiple databases up to May 2020.
• Included studies with sensitivity/specificity data and a validation sample, excluding those outside primary care.

Main Results:

• 24 studies with 14,635 participants were included.
• Micro-spirometers demonstrated a higher Area Under the Curve (AUC) of 0.84 compared to COPD-PS (0.77) and CDQ (0.72) questionnaires.
• The difference in AUC between micro-spirometers and the CDQ was statistically significant.

Conclusions:

• Micro-spirometers are more accurate for COPD diagnosis than the COPD-PS and CDQ questionnaires.
• Questionnaires identify symptomatic patients, but handheld devices offer superior diagnostic performance.
• Combining tools may enhance accuracy but requires further investigation.