COPD Diagnostic Questionnaire (CDQ) for selecting at-risk patients for spirometry: A cross-sectional study in Australian general practice

Anthony J. Stanley, Iqbal Hasan, Alan J. Crockett, Onno C.P. Van Schayck, Nicholas A. Zwar

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Abstract

Background: Using the COPD Diagnostic Questionnaire (CDQ) as a selection tool for spirometry could potentially improve the efficiency and accuracy of chronic obstructive pulmonary disease (COPD) diagnosis in at-risk patients. Aim: To identify an optimal single cut point for the CDQ that divides primary care patients into low or high likelihood of COPD, with the latter group undergoing spirometry. Methods: Former or current smokers aged 40-85 years with no prior COPD diagnosis were invited to a case-finding appointment with the practice nurse at various general practices in Sydney, Australia. The CDQ was collected and pre- and post-bronchodilator spirometry was performed. Cases with complete CDQ data and spirometry meeting quality standards were analysed (1,054 out of 1,631 patients). CDQ cut points were selected from a receiver operating characteristic (ROC) curve. Results: The area under the ROC curve was 0.713. A cut point of 19.5 had the optimal combination of sensitivity (63%) and specificity (70%) with two-thirds below this cut point. A cut point of 14.5 corresponded to a sensitivity of 91%, specificity of 35% and negative predictive value of 96%, and 31% of patients below this cut point. Conclusions: The CDQ can be used to select patients at risk of COPD for spirometry using one cut point. We consider two possible cut points. The 19.5 cut point excludes a higher proportion of patients from undergoing spirometry with the trade-off of more false negatives. The 14.5 cut point has a high sensitivity and negative predictive value, includes more potential COPD cases but has a higher rate of false positives.

Original languageEnglish
Article number14024
Journalnpj Primary Care Respiratory Medicine
Volume24
DOIs
Publication statusPublished - 10 Jul 2014
Externally publishedYes

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Spirometry
General Practice
Chronic Obstructive Pulmonary Disease
Cross-Sectional Studies
Bronchodilator Agents
ROC Curve
Surveys and Questionnaires
Sensitivity and Specificity
Primary Health Care
Appointments and Schedules
Nurses

Cite this

@article{93a16f116c1d4513be6c19d5ca665f3e,
title = "COPD Diagnostic Questionnaire (CDQ) for selecting at-risk patients for spirometry: A cross-sectional study in Australian general practice",
abstract = "Background: Using the COPD Diagnostic Questionnaire (CDQ) as a selection tool for spirometry could potentially improve the efficiency and accuracy of chronic obstructive pulmonary disease (COPD) diagnosis in at-risk patients. Aim: To identify an optimal single cut point for the CDQ that divides primary care patients into low or high likelihood of COPD, with the latter group undergoing spirometry. Methods: Former or current smokers aged 40-85 years with no prior COPD diagnosis were invited to a case-finding appointment with the practice nurse at various general practices in Sydney, Australia. The CDQ was collected and pre- and post-bronchodilator spirometry was performed. Cases with complete CDQ data and spirometry meeting quality standards were analysed (1,054 out of 1,631 patients). CDQ cut points were selected from a receiver operating characteristic (ROC) curve. Results: The area under the ROC curve was 0.713. A cut point of 19.5 had the optimal combination of sensitivity (63{\%}) and specificity (70{\%}) with two-thirds below this cut point. A cut point of 14.5 corresponded to a sensitivity of 91{\%}, specificity of 35{\%} and negative predictive value of 96{\%}, and 31{\%} of patients below this cut point. Conclusions: The CDQ can be used to select patients at risk of COPD for spirometry using one cut point. We consider two possible cut points. The 19.5 cut point excludes a higher proportion of patients from undergoing spirometry with the trade-off of more false negatives. The 14.5 cut point has a high sensitivity and negative predictive value, includes more potential COPD cases but has a higher rate of false positives.",
author = "Stanley, {Anthony J.} and Iqbal Hasan and Crockett, {Alan J.} and {Van Schayck}, {Onno C.P.} and Zwar, {Nicholas A.}",
year = "2014",
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COPD Diagnostic Questionnaire (CDQ) for selecting at-risk patients for spirometry : A cross-sectional study in Australian general practice. / Stanley, Anthony J.; Hasan, Iqbal; Crockett, Alan J.; Van Schayck, Onno C.P.; Zwar, Nicholas A.

In: npj Primary Care Respiratory Medicine, Vol. 24, 14024, 10.07.2014.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - COPD Diagnostic Questionnaire (CDQ) for selecting at-risk patients for spirometry

T2 - A cross-sectional study in Australian general practice

AU - Stanley, Anthony J.

AU - Hasan, Iqbal

AU - Crockett, Alan J.

AU - Van Schayck, Onno C.P.

AU - Zwar, Nicholas A.

PY - 2014/7/10

Y1 - 2014/7/10

N2 - Background: Using the COPD Diagnostic Questionnaire (CDQ) as a selection tool for spirometry could potentially improve the efficiency and accuracy of chronic obstructive pulmonary disease (COPD) diagnosis in at-risk patients. Aim: To identify an optimal single cut point for the CDQ that divides primary care patients into low or high likelihood of COPD, with the latter group undergoing spirometry. Methods: Former or current smokers aged 40-85 years with no prior COPD diagnosis were invited to a case-finding appointment with the practice nurse at various general practices in Sydney, Australia. The CDQ was collected and pre- and post-bronchodilator spirometry was performed. Cases with complete CDQ data and spirometry meeting quality standards were analysed (1,054 out of 1,631 patients). CDQ cut points were selected from a receiver operating characteristic (ROC) curve. Results: The area under the ROC curve was 0.713. A cut point of 19.5 had the optimal combination of sensitivity (63%) and specificity (70%) with two-thirds below this cut point. A cut point of 14.5 corresponded to a sensitivity of 91%, specificity of 35% and negative predictive value of 96%, and 31% of patients below this cut point. Conclusions: The CDQ can be used to select patients at risk of COPD for spirometry using one cut point. We consider two possible cut points. The 19.5 cut point excludes a higher proportion of patients from undergoing spirometry with the trade-off of more false negatives. The 14.5 cut point has a high sensitivity and negative predictive value, includes more potential COPD cases but has a higher rate of false positives.

AB - Background: Using the COPD Diagnostic Questionnaire (CDQ) as a selection tool for spirometry could potentially improve the efficiency and accuracy of chronic obstructive pulmonary disease (COPD) diagnosis in at-risk patients. Aim: To identify an optimal single cut point for the CDQ that divides primary care patients into low or high likelihood of COPD, with the latter group undergoing spirometry. Methods: Former or current smokers aged 40-85 years with no prior COPD diagnosis were invited to a case-finding appointment with the practice nurse at various general practices in Sydney, Australia. The CDQ was collected and pre- and post-bronchodilator spirometry was performed. Cases with complete CDQ data and spirometry meeting quality standards were analysed (1,054 out of 1,631 patients). CDQ cut points were selected from a receiver operating characteristic (ROC) curve. Results: The area under the ROC curve was 0.713. A cut point of 19.5 had the optimal combination of sensitivity (63%) and specificity (70%) with two-thirds below this cut point. A cut point of 14.5 corresponded to a sensitivity of 91%, specificity of 35% and negative predictive value of 96%, and 31% of patients below this cut point. Conclusions: The CDQ can be used to select patients at risk of COPD for spirometry using one cut point. We consider two possible cut points. The 19.5 cut point excludes a higher proportion of patients from undergoing spirometry with the trade-off of more false negatives. The 14.5 cut point has a high sensitivity and negative predictive value, includes more potential COPD cases but has a higher rate of false positives.

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M3 - Article

VL - 24

JO - Primary Care Respiratory Journal

JF - Primary Care Respiratory Journal

SN - 1475-1534

M1 - 14024

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