■肺活量测定的使用不足阻碍了初级保健中COPD的诊断。使用经过验证的症状和健康状况问卷进行病例发现,和简单的手持设备在高危人群可以提高诊断。本研究旨在确定在初级保健环境中优化COPD诊断的最佳措施组合。
■我们招募了335名当前或戒烟者,包括那些从一般实践中确诊为COPD的患者。使用手持式肺活量测定装置(COPD-6®)测量参与者的FEV1和FEV6。每个人都完成了COPD评估测试(CAT),改良的医学研究理事会(mMRC)呼吸困难量表,圣乔治呼吸问卷(SGRQ)和吸烟史问卷。根据这些数据,我们计算了肺活量测定确认的COPD诊断的预测有效性。接收器工作特性曲线下面积(AUROC),灵敏度,特异性,阳性和阴性预测值(PPV,分别计算NPV)。Kappa系数用于测量固定比率(FR)和正常下限(LLN)肺活量测定标准在诊断COPD中的一致性。
■单独使用FEV1/FEV6<0.70与COPD诊断显著相关(p<0.0001),预测准确性好(AUROC=0.725)。然而,结合SGRQ后没有发现进一步的改善,CAT和mMRC与FEV1/FEV6。使用COPD-6®手持设备的FEV1/FEV6<0.70具有中等灵敏度(65.7%)和高PPV(90.1%),高特异性(79.3%)和净现值(44.8%)。FR和LLN定义之间有很好的一致性(κ=0.70)。
■手持式微量肺活量计可以帮助吸烟者和参加全科治疗的戒烟者发现COPD的病例。COPD-X指南目前推荐的固定比率标准提供了在澳大利亚初级保健中诊断COPD的最简单方法。
Diagnosis of COPD in primary care is hindered by underuse of
spirometry.
Case finding using validated symptom and health status questionnaires, and simple handheld devices in high-risk populations may improve diagnosis. This study aimed to determine the best combination of measures to optimise COPD diagnosis in the primary care setting.
We recruited 335 current or ex-smokers, including those with an established diagnosis of COPD from general practices. Participants\' FEV1 and FEV6 were measured using a handheld
spirometry device (COPD-6®). Each completed the COPD assessment test (CAT), a modified Medical Research Council (mMRC) dyspnoea scale, St George\'s Respiratory Questionnaire (SGRQ) and smoking history questionnaire. From these data we calculated the predictive validity for
spirometry-confirmed diagnosis of COPD. Area under the receiver operating characteristic curve (AUROC), sensitivity, specificity, positive and negative predictive values (PPV, NPV) were calculated for each. Kappa coefficient was used to measure the agreement between the Fixed-Ratio (FR) and Lower Limit of Normal (LLN) spirometric criteria in diagnosing COPD.
FEV1/FEV6 <0.70 alone showed significant association (p<0.0001) with COPD diagnosis and good predictive accuracy (AUROC=0.725). However, no further improvement was found after combining SGRQ, CAT and mMRC with FEV1/FEV6. FEV1/FEV6 <0.70 using the COPD-6® handheld device had moderate sensitivity (65.7%) and high PPV (90.1%), high specificity (79.3%) and NPV (44.8%). There was good agreement between FR and LLN definitions (κ=0.70).
Handheld micro-spirometers can facilitate
case finding of COPD in smokers and ex-smokers attending general practice. The fixed ratio criterion currently recommended by COPD-X guidelines offers the simplest method for diagnosing COPD in Australian primary care.