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Obstructive Lung Diseases |

Identifying Patients With Undiagnosed Clinically-Significant COPD in Primary Care: What Questions Should We Be Asking?

Fernando Martinez, MD; David Mannino, MD; Nancy Leidy, PhD; Elizabeth Bacci, PhD; R Barr, MD; Russ Bowler, MD; Meilan Han, MD; Julia Houfek, PhD; Karen Malley, BA; Catherine Meldrum, PhD; Stephen Rennard, MD; Byron Thomashow, MD; John Walsh; Barbara Yawn, MD
Author and Funding Information

Cornell University, New York, NY


Chest. 2015;148(4_MeetingAbstracts):696A. doi:10.1378/chest.2273164
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Abstract

SESSION TITLE: COPD Posters II

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 28, 2015 at 01:30 PM - 02:30 PM

PURPOSE: We are developing a new method (questionnaire + peak expiratory flow [PEF]) for identifying patients in need of spirometric evaluation for clinically significant COPD in primary care settings. A pool of 48 candidate items was developed based on insight from the literature, mining existing datasets, and qualitative research. The purpose of this study was to select the best sets of questions from this item pool for further testing.

METHODS: Prospective, cross-sectional, multi-site case-control study. Subjects: ≥ 40 years recruited through US pulmonary and primary care clinics. Cases: ≥ 1 exacerbation past 12 months or FEV1 < 60% predicted, exacerbation-free ≥ 12 months. Controls: mild COPD, exacerbation-free ≥ 12 months or no COPD. Subjects completed a questionnaire booklet, PEF, and spirometry (if not on record). Random forests methodology was used to identify the best, smallest sets of questions (with and without PEF) capable of case identification.

RESULTS: N=346 (186 Cases, 160 Controls). Mean (SD) age=62.7 (10.1) years; 55% female; 86% white; 41% ≤ high school; 16% never smoked. Cases: FEV1% predicted=42.5 (14.2); Controls=82.5 (15.7). PEF results are presented elsewhere. Precision estimates (% overall error, sensitivity, specificity) for case-control comparisons during item reduction were as follows: 46 items: 24.6; 80.4; 70.4; 34 items: 22.6; 81.1; 73.8; 21 items: 23.7, 80.2, 72.4; 8 items: 21.3, 83.1, 74.3; 5-item version 1: 23.4; 83.5, 69.7; 5-item version 2: 26.6, 73.8, 73.0. Including PEF improved precision: 8 items: 17.0, 84.7, 81.2; 5-item version 1: 18.2, 84.8, 78.7; 5-item version 2: 21.1, 81.4, 76.5. The best item sets included questions related to exposure, symptoms, impact, and recent respiratory history.

CONCLUSIONS: The number of items was reduced while maintaining error rates, yielding three sets of 5 to 8 questions that are being further tested to derive the most accurate and parsimonious questionnaire for case identification.

CLINICAL IMPLICATIONS: Using a combination of questionnaire and PEF may be an efficient approach for identifying patients in primary care needing diagnostic evaluation for clinically significant COPD.

DISCLOSURE: Fernando Martinez: Consultant fee, speaker bureau, advisory committee, etc.: Boehringer Ingelheim, Other: CME Incite (CME presentations), Other: CSAII CME presentation, Consultant fee, speaker bureau, advisory committee, etc.: Forest, Consultant fee, speaker bureau, advisory committee, etc.: Genentech, Other: Gilead IPF Steering Committee, Consultant fee, speaker bureau, advisory committee, etc.: Haymarket research, Consultant fee, speaker bureau, advisory committee, etc.: Ikaria/Bellerophon, Other: Janssens ad board and SC, Consultant fee, speaker bureau, advisory committee, etc.: Veracyte, Other: Medscape and WebMD CME presentation, Other: Miller and NACE CME presentations, Other: Nycomed/Takeda ad board/speaking/SC, Consultant fee, speaker bureau, advisory committee, etc.: Pearl, Consultant fee, speaker bureau, advisory committee, etc.: Roche David Mannino: Grant monies (from industry related sources): Glaxo SmithKline, Grant monies (from industry related sources): Novartis, Consultant fee, speaker bureau, advisory committee, etc.: GlaxoSmithKline, Consultant fee, speaker bureau, advisory committee, etc.: Novartis, Consultant fee, speaker bureau, advisory committee, etc.: Boehringer-Ingelhiem, Consultant fee, speaker bureau, advisory committee, etc.: Astra-Zeneca, Consultant fee, speaker bureau, advisory committee, etc.: Sunovion, Consultant fee, speaker bureau, advisory committee, etc.: Amgen, Consultant fee, speaker bureau, advisory committee, etc.: Up-to-Date, Other: Expert Witness- Various Law firms, Other: Board of Directors, COPD Foundation Nancy Leidy: Employee: Employed by Evidera, a health care research firm that provides consulting and other research services to pharmaceutical, device, government, and non-government organizations. In this salaried position, employees work with a variety of companies and organizations and receive no payment or honoraria directly from these organizations for services rendered. Elizabeth Bacci: Employee: Employed by Evidera, a health care research firm that provides consulting and other research services to pharmaceutical, device, government, and non-government organizations. In this salaried position, employees work with a variety of companies and organizations and receive no payment or honoraria directly from these organizations for services rendered. R Barr: Grant monies (from industry related sources): Dr. Barr received grant support from NIH, US-EPA, and the Alpha1 Foundation, Other: Dr. Barr has received royalties from UpToDate Russ Bowler: Consultant fee, speaker bureau, advisory committee, etc.: Boehringer Ingelheim Advisory Board Meilan Han: Consultant fee, speaker bureau, advisory committee, etc.: GSK, Consultant fee, speaker bureau, advisory committee, etc.: BI, Consultant fee, speaker bureau, advisory committee, etc.: Regeneron Karen Malley: Employee: Employed by Evidera, a health care research firm that provides consulting and other research services to pharmaceutical, device, government, and non-government organizations. In this salaried position, employees work with a variety of companies and organizations and receive no payment or honoraria directly from these organizations for services rendered. Stephen Rennard: Consultant fee, speaker bureau, advisory committee, etc.: ABIM, Consultant fee, speaker bureau, advisory committee, etc.: Advantage Heathcare, Consultant fee, speaker bureau, advisory committee, etc.: American Thoracic Society, Other: AstraZeneca, Consultant fee, speaker bureau, advisory committee, etc.: Baxter, Consultant fee, speaker bureau, advisory committee, etc.: Boehringer Ingelheim, Consultant fee, speaker bureau, advisory committee, etc.: Chiesi, Consultant fee, speaker bureau, advisory committee, etc.: ClearView Healthcare, Other: Cleveland Clinic, Consultant fee, speaker bureau, advisory committee, etc.: Complete Medical Group, Consultant fee, speaker bureau, advisory committee, etc.: CSL, Consultant fee, speaker bureau, advisory committee, etc.: Dailchi Sankyo, Consultant fee, speaker bureau, advisory committee, etc.: Decision Resources, Consultant fee, speaker bureau, advisory committee, etc.: Forest, Consultant fee, speaker bureau, advisory committee, etc.: Gerson Lehman Byron Thomashow: Consultant fee, speaker bureau, advisory committee, etc.: consultant Boehringer Ingelheim, Consultant fee, speaker bureau, advisory committee, etc.: advisory board GSK, Consultant fee, speaker bureau, advisory committee, etc.: advisory board Novartis, Consultant fee, speaker bureau, advisory committee, etc.: advisory board AstraZeneca Barbara Yawn: Consultant fee, speaker bureau, advisory committee, etc.: COPD advisory committee for primary care to BI The following authors have nothing to disclose: Julia Houfek, Catherine Meldrum, John Walsh

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