2 research outputs found
A Novel Case-Finding Instrument for Chronic Obstructive Pulmonary Disease in Low- and Middle-Income Country Settings
Background: Low- and middle-income countries (LMICs) account for >90% of deaths and
illness episodes related to COPD; however, this condition is commonly underdiagnosed in
these settings. Case-finding instruments for COPD may improve diagnosis and identify
individuals that need treatment, but few have been validated in resource-limited settings.
Methods: We conducted a population-based cross-sectional study in Uganda to assess the
diagnostic accuracy of a respiratory symptom, exposure and functional questionnaire in
combination with peak expiratory flow for COPD diagnosis using post-bronchodilator
FEV1/FVC z-score below the 5th percentile as the gold standard. We included locally
relevant exposure questions and statistical learning techniques to identify the most important
risk factors for COPD. We used 80% of the data to develop the case-finding instrument and
validated it in the remaining 20%. We evaluated for calibration and discrimination using
standard approaches. The final score, COLA (COPD in LMICs Assessment), included seven
questions, age and pre-bronchodilator peak expiratory flow.
Results: We analyzed data from 1,173 participants (average age 47 years, 46.9% male, 4.5%
with COPD) with acceptable and reproducible spirometry. The seven questions yielded
a cross-validated area-under-the-curve [AUC] of 0.68 (95% CI 0.61–0.75) with higher scores
conferring greater odds of COPD. The inclusion of peak expiratory flow and age improved
prediction in a validation sample (AUC=0.83, 95% CI 0.78–0.88) with a positive predictive
value of 50% and a negative predictive value of 96%. The final instrument (COLA) included
seven questions, age and pre-bronchodilator peak expiratory flow.
Conclusion: COLA predicted COPD in urban and rural settings in Uganda has high
calibration and discrimination, and could serve as a simple, low-cost screening tool in
resource-limited settings
A Novel Case-Finding Instrument for Chronic Obstructive Pulmonary Disease in Low- and Middle-Income Country Settings.
Background: Low- and middle-income countries (LMICs) account for >90% of deaths and illness episodes related to COPD; however, this condition is commonly underdiagnosed in these settings. Case-finding instruments for COPD may improve diagnosis and identify individuals that need treatment, but few have been validated in resource-limited settings. Methods: We conducted a population-based cross-sectional study in Uganda to assess the diagnostic accuracy of a respiratory symptom, exposure and functional questionnaire in combination with peak expiratory flow for COPD diagnosis using post-bronchodilator FEV1/FVC z-score below the 5th percentile as the gold standard. We included locally relevant exposure questions and statistical learning techniques to identify the most important risk factors for COPD. We used 80% of the data to develop the case-finding instrument and validated it in the remaining 20%. We evaluated for calibration and discrimination using standard approaches. The final score, COLA (COPD in LMICs Assessment), included seven questions, age and pre-bronchodilator peak expiratory flow. Results: We analyzed data from 1,173 participants (average age 47 years, 46.9% male, 4.5% with COPD) with acceptable and reproducible spirometry. The seven questions yielded a cross-validated area-under-the-curve [AUC] of 0.68 (95% CI 0.61-0.75) with higher scores conferring greater odds of COPD. The inclusion of peak expiratory flow and age improved prediction in a validation sample (AUC=0.83, 95% CI 0.78-0.88) with a positive predictive value of 50% and a negative predictive value of 96%. The final instrument (COLA) included seven questions, age and pre-bronchodilator peak expiratory flow. Conclusion: COLA predicted COPD in urban and rural settings in Uganda has high calibration and discrimination, and could serve as a simple, low-cost screening tool in resource-limited settings