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

IF 6.6 2区医学 Q1 RESPIRATORY SYSTEM

Respirology Pub Date : 2025-06-01 Epub Date: 2025-02-11 DOI:10.1111/resp.70000

Po-Chun Lo, Hsin-Kuo Ko, Kun-Ta Chou, Yi-Han Hsiao, Diahn-Warng Perng, Kang-Cheng Su

{"title":"A Two-Staged, Risk-Stratified Strategy Combining FEV1/FEV6 and COPD Diagnostic Questionnaire Acts as an Accurate and Cost-Effective COPD Case-Finding Method.","authors":"Po-Chun Lo, Hsin-Kuo Ko, Kun-Ta Chou, Yi-Han Hsiao, Diahn-Warng Perng, Kang-Cheng Su","doi":"10.1111/resp.70000","DOIUrl":null,"url":null,"abstract":"Background and objective: Symptom-based questionnaires and handheld lung function devices are widely used for COPD case finding, but the optimal combination remains unclear. This study aimed to compare the diagnostic accuracy (DA) of various combinations of handheld lung function devices and questionnaires and develop a COPD case-finding strategy.Methods: This cross-sectional, prospective, observational study enrolled participants aged ≥ 40 years with respiratory symptoms and ≥ 10 smoking pack-years. Participants completed three questionnaires (COPD diagnostic questionnaire [CDQ], lung function questionnaire; COPD Population Screener) and 2 handheld lung function devices (peak flow meter, microspirometer), followed by spirometry to confirm COPD (post-bronchodilation FEV1/FVC < 0.7). DA is assessed using the area under the ROC curve (AUROC).Results: Among 224 participants, COPD incidence was 29%. Individually, handheld devices showed significantly higher DA than questionnaires (AUROC 0.678-0.69 for questionnaires vs. 0.807 for peak expiratory flow rate [PEFR] and 0.888 for FEV1/FEV6; all pairwise p < 0.05). FEV1/FEV6-based combinations outperformed PEFR-based combinations (all n = 224; AUROC 0.897-0.903 vs. 0.810-0.818; p < 0.05). The CDQ and FEV1/FEV6 combination reached the highest DA (AUROC 0.903). FEV1/FEV6 < 0.76 was the optimal cutoff value. A two-staged strategy (sensitivity/specificity 0.82/0.84) was proposed: low-risk participants (CDQ ≤ 13) need no further testing; middle-risk (CDQ 14-26) should undergo FEV1/FEV6; and high-risk (CDQ ≥ 27) and middle-risk with FEV1/FEV6 < 0.76 require confirmatory spirometry. This approach would reduce misdiagnoses and save costs and time compared to FEV1/FEV6 alone.Conclusion: FEV1/FEV6 and CDQ combination achieves the highest DA. A two-staged, risk-stratified strategy combining CDQ and FEV1/FEV6 can be accurate and cost-effective to detect at-risk, undiagnosed COPD subjects. External validation is required.","PeriodicalId":21129,"journal":{"name":"Respirology","volume":" ","pages":"493-503"},"PeriodicalIF":6.6000,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Respirology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1111/resp.70000","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/2/11 0:00:00","PubModel":"Epub","JCR":"Q1","JCRName":"RESPIRATORY SYSTEM","Score":null,"Total":0}

引用次数: 0

Abstract

Background and objective: Symptom-based questionnaires and handheld lung function devices are widely used for COPD case finding, but the optimal combination remains unclear. This study aimed to compare the diagnostic accuracy (DA) of various combinations of handheld lung function devices and questionnaires and develop a COPD case-finding strategy.

Methods: This cross-sectional, prospective, observational study enrolled participants aged ≥ 40 years with respiratory symptoms and ≥ 10 smoking pack-years. Participants completed three questionnaires (COPD diagnostic questionnaire [CDQ], lung function questionnaire; COPD Population Screener) and 2 handheld lung function devices (peak flow meter, microspirometer), followed by spirometry to confirm COPD (post-bronchodilation FEV₁/FVC < 0.7). DA is assessed using the area under the ROC curve (AUROC).

Results: Among 224 participants, COPD incidence was 29%. Individually, handheld devices showed significantly higher DA than questionnaires (AUROC 0.678-0.69 for questionnaires vs. 0.807 for peak expiratory flow rate [PEFR] and 0.888 for FEV₁/FEV₆; all pairwise p < 0.05). FEV₁/FEV₆-based combinations outperformed PEFR-based combinations (all n = 224; AUROC 0.897-0.903 vs. 0.810-0.818; p < 0.05). The CDQ and FEV₁/FEV₆ combination reached the highest DA (AUROC 0.903). FEV₁/FEV₆ < 0.76 was the optimal cutoff value. A two-staged strategy (sensitivity/specificity 0.82/0.84) was proposed: low-risk participants (CDQ ≤ 13) need no further testing; middle-risk (CDQ 14-26) should undergo FEV₁/FEV₆; and high-risk (CDQ ≥ 27) and middle-risk with FEV₁/FEV₆ < 0.76 require confirmatory spirometry. This approach would reduce misdiagnoses and save costs and time compared to FEV₁/FEV₆ alone.

Conclusion: FEV₁/FEV₆ and CDQ combination achieves the highest DA. A two-staged, risk-stratified strategy combining CDQ and FEV₁/FEV₆ can be accurate and cost-effective to detect at-risk, undiagnosed COPD subjects. External validation is required.

查看原文本刊更多论文

结合 FEV1/FEV6 和慢性阻塞性肺病诊断问卷的两阶段风险分级策略是一种准确且经济高效的慢性阻塞性肺病病例查找方法。

背景与目的：基于症状的问卷和手持式肺功能装置被广泛用于COPD病例发现，但最佳组合尚不清楚。本研究旨在比较手持式肺功能装置和问卷的各种组合的诊断准确性（DA），并制定COPD病例发现策略。方法：这项横断面、前瞻性、观察性研究纳入年龄≥40岁、有呼吸道症状且吸烟包年≥10年的参与者。参与者完成3份问卷(COPD诊断问卷[CDQ]、肺功能问卷；COPD人群筛查器)和2个手持式肺功能仪（峰值流量仪、微肺活量计），随后进行肺活量测定以确诊COPD（支气管扩张后FEV1/FVC）。单独而言，手持设备的DA显著高于问卷调查(问卷调查的AUROC为0.678-0.69，呼气峰流速[PEFR]为0.807，FEV1/FEV6为0.888；所有基于p 1/ fev6的两两组合都优于基于pefr的组合(所有n = 224；AUROC为0.897-0.903比0.810-0.818；p 1/FEV6组合DA最高（AUROC为0.903）。FEV1 / FEV6 1 / FEV6;高危（CDQ≥27）和中危（单独FEV1/FEV6 1/FEV6）。结论：FEV1/FEV6和CDQ组合DA最高。结合CDQ和FEV1/FEV6的两阶段风险分层策略可以准确且具有成本效益地检测有风险的未确诊COPD患者。需要外部验证。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Respirology 医学-呼吸系统

CiteScore

10.60

自引率

5.80%

发文量

225

审稿时长

1 months

期刊介绍： Respirology is a journal of international standing, publishing peer-reviewed articles of scientific excellence in clinical and clinically-relevant experimental respiratory biology and disease. Fields of research include immunology, intensive and critical care, epidemiology, cell and molecular biology, pathology, pharmacology, physiology, paediatric respiratory medicine, clinical trials, interventional pulmonology and thoracic surgery. The Journal aims to encourage the international exchange of results and publishes papers in the following categories: Original Articles, Editorials, Reviews, and Correspondences. Respirology is the preferred journal of the Thoracic Society of Australia and New Zealand, has been adopted as the preferred English journal of the Japanese Respiratory Society and the Taiwan Society of Pulmonary and Critical Care Medicine and is an official journal of the World Association for Bronchology and Interventional Pulmonology.