1. External multicentric validation of a COPD detection questionnaire.
Bergna M., Garcia G, Alchapar R, Altieri H, Caberlotto O, Figueroa Casas J,
Larrateguy L, Nannini L, Pascansky D, Grabre P, Zabert G, Fucile S.
Immunology and Obstructive Diseases, Scientific Department ; from Argentine Respiratory Medicine Association.
LOGO OF YOUR UNIVERSITY/INSTITUTION
Results
Introduction
Results. 485 subjects were evaluated. Of these 17 (3.5%) were excluded due to not achieved of ATS/ERS spirometry acceptability criteria. From 468 patients for analysis, one hundred subjects (21.1%) had spirometric diagnosis of COPD. In univariate analysis patients with COPD had higher median age (58 years vs 54 years, p <0.001), pack years (PY) smoked (40 vs 30, P <0.001), lower BMI (26 vs 28, P = 0.02), higher incidence of males (68.8% vs 43.9%, P <0.001), cough for 3 months (55.2% vs 35.8%, P = 0.001), chronic cough (47.9% vs 28.8%, P <0.001 ), phlegm for 3 months (50% vs 37.2, P = 0.02), chronic phlegm (40.6% vs 26.1%, P = 0.005), dyspnea (62.5% vs 51.9%, P = 0.06), wheezing (55.2% vs 47%, P = 0.15), wheezing without infection (38.5% vs 33.9%, P = 0.39), stove at home (10.4% vs 7.5%, P = 0.35) and risk profession (19.8% vs 18.5 %, P = 0.78) although the latter variables did not show statistical significance. The median FEV1 in COPD was significantly lower (2.14 L vs 2.76 L, P <0.001) The following variables were selected for multivariate analysis, continuous variables were divided by quartiles of greatest risk: age ≥ 58 years (OR 2.55, 95% CI , P = 0.01), PY ≥ 40 (OR 2.21, 95% CI , P = 0.02), BMI ≤ 22 (OR 2.55, 95% CI , P <0.001), male gender (OR 2.19, 95% CI , P = 0.001), chronic cough ( OR 2.05, 95% CI , P = 0.01), chronic phlegm (OR 1.07, 95% CI , P = 0.81) and dyspnea (OR 1.30, 95% CI , P = 0.32). The remaining variables did not provide significance to the model. The area under the ROC curve of the model was 0.75 (95% CI 0.70 to 0.80, p <0.001). The absence or presence of these seven variables (age ≥ 58 years, PY ≥ 40, BMI ≤ 22, sex, chronic cough, chronic phlegm and dyspnea exercise or rest) were tested to assess the best cuts of sensitivity and specificity. The presence of at least 3 of these variables had a sensitivity of 95% and a specificity of 25.29%, positive predictive value (PPV) of 22.62% and negative (NPV) of 95.65%. The presence of at least 6 variables had a sensitivity of 90% and a specificity of 70.97%, a PPV of 50% and a NPV of 95.65%
Chronic obstructive pulmonary disease (COPD) is a preventable disease, whose mortality rate is increasing and is predicted to be the third leading cause of death worldwide in 20 years. Early diagnosis and better disease management are priorities. According to the study Platino, COPD is underdiagnosed by 89%.Diagnosis is by spirometry. Usually patients with mild and moderate states have no symptoms and do not seek medical care. The development of a simple questionnaire can help clinicians to improve diagnosis in the asymptomatic population or with few symptoms
Objective: External validation of the questionnaire to detect COPD in Argentina.
Methods
We were performed a questionnaire in subjects with over 40 years old and history of smoking ≥ 10 or more pack / year in 10 cities from Argentina. Demographic data and pre and post bronchodilator spirometry were performed. Subjects with previous diagnosis of COPD or asthma were excluded. Continuous variables were analyzed by t test or Mann Whitney. We performed multiple logistic regression and statistically and clinically relevant variables, were modeled by the absence or presence to test its sensitivity, specificity, predictive values ​​and area under the ROC curve
Conclusions
 This simple questionnaire for demographic and clinical data can be useful for detection of COPD.
This work was supported by a sponsorship of Novartis Laboratories
Acknowledgement
Bibliography
Hannania N, et al. Predicting risk of airflow obstruction in primary care: Validation of the lung function questionnaire (LFQ). Respiratory_Medicine_2010_104_(8)1160
Global initiative for chronic obstructive lung disease. Execu-tive summary . National Institutes of Health: National Heart, Lung, and Blood Institute. Available at:
Yawn BP, Mapel DW, Mannino DM, et al. Development of the lung function questionnaire (LFQ) to identify airflow obstruc-tion. Int J COPD 2010;5:1 e10.
Price D, Tinkelman D, Nordyke R, et al. Scoring system and clinical application of COPD diagnostic questionnaires. Chest 2006;129 :1531