英国伦敦大学学院John R. Hurst团队联合美国迈阿密大学Trishul Siddharthan团队研究了3个中低收入国家慢性阻塞性肺病筛查工具的鉴别准确性。这一研究成果发表在2022年1月11日出版的《美国医学会杂志》上。

全球慢性阻塞性肺病（COPD）的发病和死亡大多发生在中低收入国家（LMIC），具有显著的经济影响。

为了通过问卷调查和呼气峰值流量（PEF）来评估3种仪器在3种LMIC环境中筛查COPD的准确性，2018年1月至2020年3月，研究组在尼泊尔、秘鲁和乌干达进行了一项鉴别准确性的横断面分析，对40岁以上的人群进行随机年龄和性别分层抽样。

进行评估的3种筛查工具分别为：在初级保健中确定未诊断呼吸系统疾病和加重风险的COPD评估（CAPTURE），中低收入国家慢性阻塞性肺病评估问卷（COLA-6），肺功能问卷（LFQ），将其与使用有质量保证的支气管扩张剂后肺活量测定法诊断COPD的参考标准相比较。CAPTURE和COLA-6包括PEF的测量。主要结局是通过95%置信区间的受试者工作特征曲线下面积（AUCs）测量工具识别COPD的鉴别准确性。次要结局包括敏感性、特异性、阳性预测值和阴性预测值。

共有10709名成年人同意参与研究，平均年龄为56.3岁，50%为女性，35%曾吸烟，30%目前暴露在生物质烟雾中。3个地点COPD的非加权患病率在尼泊尔为18.2%，在秘鲁为2.7%，在乌干达为7.4%。在1000例COPD病例中，49.3%有临床重大疾病（全球慢性阻塞性肺病分级B-D倡议），16.4%有严重或非常严重的气流阻塞（1秒用力呼气量<50%预测），95.3%的病例以前未被诊断。秘鲁LFQ的AUC为0.717，尼泊尔COLA-6的AUC为0.791。在尼泊尔，COLA-6的敏感性为34.8%，CAPTURE的敏感性为64.2%。仪器的平均操作时间为7.6分钟，数据完整性为99.5%。

研究结果表明，COPD筛查仪器在3个中低收入国家是可行的。仍需进一步研究来评估仪器在其他中低收入环境中的性能，并确定其实施是否与临床预后改善相关。

附：英文原文

Title: Discriminative Accuracy of Chronic Obstructive Pulmonary Disease Screening Instruments in 3 Low- and Middle-Income Country Settings

Author: Trishul Siddharthan, Suzanne L. Pollard, Shumonta A. Quaderi, Natalie A. Rykiel, Adaeze C. Wosu, Patricia Alupo, Julie A. Barber, Maria Kathia Cárdenas, Ram K. Chandyo, Oscar Flores-Flores, Bruce Kirenga, J. Jaime Miranda, Sakshi Mohan, Federico Ricciardi, Arun K. Sharma, Santa Kumar Das, Laxman Shrestha, Marta O. Soares, William Checkley, John R. Hurst, GECo Study Investigators, Susan Michie, Zachos Anastasiou, Shakir Hossen, Nicole Robertson, Robert A Wise, Karbir Nath Yogi, Denis Mawanda, Faith Nassali, Robert Kalyesubula, Elisa Romani-Huacani, Adithya Cattamanchi

Issue&Volume: 2022/01/11

Abstract:

Importance  Most of the global morbidity and mortality in chronic obstructive pulmonary disease (COPD) occurs in low- and middle-income countries (LMICs), with significant economic effects.

Objective  To assess the discriminative accuracy of 3 instruments using questionnaires and peak expiratory flow (PEF) to screen for COPD in 3 LMIC settings.

Design, Setting, and Participants  A cross-sectional analysis of discriminative accuracy, conducted between January 2018 and March 2020 in semiurban Bhaktapur, Nepal; urban Lima, Peru; and rural Nakaseke, Uganda, using a random age- and sex-stratified sample of the population 40 years or older.

Exposures  Three screening tools, the COPD Assessment in Primary Care to Identify Undiagnosed Respiratory Disease and Exacerbation Risk (CAPTURE; range, 0-6; high risk indicated by a score of 5 or more or score 2-5 with low PEF [<250 L/min for females and <350 L/min for males]), the COPD in LMICs Assessment questionnaire (COLA-6; range, 0-5; high risk indicated by a score of 4 or more), and the Lung Function Questionnaire (LFQ; range, 0-25; high risk indicated by a score of 18 or less) were assessed against a reference standard diagnosis of COPD using quality-assured postbronchodilator spirometry. CAPTURE and COLA-6 include a measure of PEF.

Main Outcomes and Measures  The primary outcome was discriminative accuracy of the tools in identifying COPD as measured by area under receiver operating characteristic curves (AUCs) with 95% CIs. Secondary outcomes included sensitivity, specificity, positive predictive value, and negative predictive value.

Results  Among 10709 adults who consented to participate in the study (mean age, 56.3 years (SD, 11.7); 50% female), 35% had ever smoked, and 30% were currently exposed to biomass smoke. The unweighted prevalence of COPD at the 3 sites was 18.2% (642/3534 participants) in Nepal, 2.7% (97/3550) in Peru, and 7.4% (264/3580) in Uganda. Among 1000 COPD cases, 49.3% had clinically important disease (Global Initiative for Chronic Obstructive Lung Disease classification B-D), 16.4% had severe or very severe airflow obstruction (forced expiratory volume in 1 second <50% predicted), and 95.3% of cases were previously undiagnosed. The AUC for the screening instruments ranged from 0.717 (95% CI, 0.677-0.774) for LFQ in Peru to 0.791 (95% CI, 0.770-0.809) for COLA-6 in Nepal. The sensitivity ranged from 34.8% (95% CI, 25.3%-45.2%) for COLA-6 in Nepal to 64.2% (95% CI, 60.3%-67.9%) for CAPTURE in Nepal. The mean time to administer the instruments was 7.6 minutes (SD 1.11), and data completeness was 99.5%.

Conclusions and Relevance  This study demonstrated that screening instruments for COPD were feasible to administer in 3 low- and middle-income settings. Further research is needed to assess instrument performance in other low- and middle-income settings and to determine whether implementation is associated with improved clinical outcomes.

DOI: 10.1001/jama.2021.23065

Source: https://jamanetwork.com/journals/jama/article-abstract/2787909