A Two-Staged, Risk-Stratified Strategy Combining FEV₁/FEV₆ and COPD Diagnostic Questionnaire Acts as an Accurate and...

Area of Science:

• Pulmonary Medicine
• Diagnostic Accuracy Studies
• Respiratory Health

Background:

• Symptom-based questionnaires and handheld lung function devices are used for COPD case finding.
• The optimal combination for diagnostic accuracy remains unclear.

Purpose of the Study:

• To compare the diagnostic accuracy of various combinations of handheld lung function devices and questionnaires for COPD.
• To develop an effective COPD case-finding strategy.

Main Methods:

• Cross-sectional, prospective, observational study of 224 participants aged ≥40 years with respiratory symptoms and ≥10 smoking pack-years.
• Utilized three questionnaires (CDQ, lung function questionnaire, COPD Population Screener) and two handheld devices (peak flow meter, microspirometer).
• Diagnostic accuracy assessed using Area Under the Receiver Operating Characteristic Curve (AUROC), with spirometry as the gold standard.

Main Results:

• FEV1/FEV6 measurements demonstrated higher diagnostic accuracy than questionnaires individually.
• Combinations using FEV1/FEV6 outperformed those using peak expiratory flow rate (PEFR).
• The combination of CDQ and FEV1/FEV6 achieved the highest diagnostic accuracy (AUROC 0.903), with an optimal cutoff of FEV1/FEV6 < 0.76.

Conclusions:

• The combination of FEV1/FEV6 and CDQ demonstrates superior diagnostic accuracy for COPD detection.
• A proposed two-staged, risk-stratified strategy using CDQ and FEV1/FEV6 is accurate and cost-effective for identifying at-risk, undiagnosed COPD.
• External validation of the proposed strategy is necessary.