The Development And Validation Of A Simple Screening Questionnaire For Chronic Obstructive Pulmonary Disease In Primary Care

Objective:To identify the risk factors of chronic obstructive pulmonary disease(COPD)of community residents,and to develop a simple screening questionnaire of COPD with validation in an unrelated population.Methods:The residents aged 40 years and over in several communities in Beijing were screened for COPD and filled out a questionnaire during February 2018 and February 2019.The risk factors of COPD were identified through single variable analysis and multivariate logistic analysis.Then,a simple screening questionnaire was developed based on the risk factors identified by the community survey.Furthermore,participants aged 40 years and over were recruited from the Department of Respiratory of Beijing Hospital during September 2020 to January 2021 to validate the performance of the simple screening questionnaire.The area under the receiver operating characteristic curve(AUROC),sensitivity,specificity,positive predictive value(PPV)and negative predictive value(NPV)at the optimal cut-off were calculated.The performance of this questionnaire was compared to that of the other established questionnaires,including CDQ,modified CDQ,COPD-SQ and COPD-PS which was recommended by the Guideline for Primary Care of COPD.Results:1.In the community survey,a total of 1888 residents were screened and 160 were diagnosed with COPD.The prevalence was 8.5%.There were 50,84,22 and 4 cases with mild,moderate,severe and extremely severe COPD.2.Single variable analysis showed significant differences of age,education level,smoking index,allergy,occupational exposure,usage of biomass,family history of chronic respiratory diseases,dyspnea,chronic phlegm and chronic cough between COPD and non-COPD groups.Multivariate analysis demonstrated that age(OR=1.29,95%CI 1.07-1.56),smoking index(OR=1.91,95%CI 1.48-2.45),usage of biomass(OR=1.33,95%CI 1.10-1.58),family history(OR=2.18,95%CI 1.14-4.00)and dyspnea(OR=3.91,95%CI 2.13-7.00)were independently associated with COPD risk.3.A simple screening questionnaire was developed according to the risk factors identified through the community survey.The questionnaire items included age(<50,50-59 and≥60 years),body mass index(<24 and≥24 kg/m2),smoking index(0-14 and≥15 pack-years),family history of chronic respiratory diseases,usage of biomass and dyspnea.The total scores of the questionnaire was 11.4.A total of 557 eligible participants,including 139 COPD patients and 418 nonCOPD controls,were recruited from Department of Respiratory of Beijing Hospital to validate the screening performance of several questionnaires.The AUROC of the simple screening questionnaire was 0.83(95%CI 0.79-0.87).The optimal cut-off to discriminate COPD from non-COPD was 6 scores,at which the sensitivity,specificity,PPV and NPV were 75.5%,73.9%,49.1%and 90.1%,respectively.The AUROC of COPD-PS,CDQ,modified CDQ and COPD-SQ were 0.83(95%CI 0.79-0.87),0.78(95%CI 0.73-0.82),0.77(95%CI 0.73-0.82)and 0.78(95%CI 0.83-0.82),respectively.The simple screening questionnaire and COPD-SQ had similar performance,which were significantly better than CDQ,modified CDQ and COPD-SQ in discriminating COPD,Stage Ⅱ-Ⅳ COPD,Stage Ⅲ-Ⅳ COPD and COPD in the population of smokers.Conclusions:1.The prevalence of COPD in several communities in Beijing was 8.5%.The rate of missed diagnosis of COPD is very high.2.Age,smoking index,usage of biomass,family history of chronic respiratory diseases were independent risk factors of COPD and dyspnea is the main symptom of COPD.3.The simple screening questionnaire developed based on the community survey had good performance in screening COPD,which was similar to COPD-PS and better than the other questionnaires.This questionnaire may be used in screening COPD in primary care.