CAPTURE and PUMA as Case-Finding Tools in Patients at Risk of COPD-A Multicenter Mexican Experience

Background/Objectives: Chronic obstructive pulmonary disease (COPD) is a significant global challenge affecting health systems, economies, and societies. There is a need to implement case-finding strategies to identify patients at risk of COPD in routine clinical practice in low- and middle-income countries where underdiagnosis is high and access to spirometry is limited. PUMA and CAPTURE questionnaires are available for COPD screening; their comparative effectiveness has not been evaluated in Mexican patients. Methods: Multicenter, cross-sectional, case-finding study. PUMA and CAPTURE with spirometry test were used in COPD screening campaigns. Adults >40 years of age with current and former smoking, exposure to wood or charcoal, with and without chronic respiratory symptoms were eligible. COPD was confirmed by a post-bronchodilator FEV1/FVC  < 0.70. Sensitivity and specificity were calculated for each questionnaire. Correlations between PUMA and CAPTURE scores and FEV1/FVC were evaluated. Propensity score matching (PSM) was performed for patients with/without COPD. Results: In total, 197 subjects were enrolled. COPD was diagnosed in 37.1% of the patients. The cut-off point for PUMA with the best sensitivity (74.0%) and specificity (51.6%) was ≥6. CAPTURE showed cut-off points of ≥3 (sensitivity 76.9%, specificity (40.9%) or ≥4 (sensitivity 61.5%, specificity 72.7%). ROC for PUMA was 0.693 (95% IC 0.618-0.768) and for CAPTURE was 0.714 (95% IC 0.570-0.857). Correlations for PUMA and CAPTURE with FEV1/FVC were -0.390 (p < 0.001) and -0.406 (p = 0.004), respectively. There were no changes in the cut-off points and correlations after the PSM for PUMA or CAPTURE to identify patients with COPD. Conclusions: In Mexican patients, both questionnaires had moderate certainty in the diagnosis of patients at risk for COPD with a spirometric obstructive pattern.