美国明尼苏达大学Barbara P. Yawn团队研究了CAPTURE工具在美国初级保健机构中识别慢性阻塞性肺病的准确性。该研究于2023年2月14日发表在《美国医学会杂志》上。

慢性阻塞性肺疾病（COPD）在初级保健中存在诊断不足的情况。

该研究旨在评估CAPTURE（COPD初级保健评估以识别未诊断的呼吸道疾病和加重风险） 筛查工具的操作特征，以识别美国初级保健中未诊断的、临床显著的COPD患者。在这项横断面研究中，2018年10月12日至2022年4月1日，美国7个基于初级保健实践的研究网络招募了4679名45岁至80岁的初级保健患者，之前没有COPD诊断。收集CAPTURE问卷应答、呼气峰值流量率、COPD评估测试分数、急性呼吸道疾病史、人口统计学和肺活量测定结果。

暴露因素为未确诊COPD。主要结局是CAPTURE工具在识别未诊断的临床显著COPD患者时的敏感性和特异性。次要结局包括对不同阈值的分析，以确定临床意义重大的COPD阳性筛查结果。阳性筛查结果定义为：(1)CAPTURE问卷得分为5分或6分或(2)问卷得分为2分、3分或4分，且女性呼气流量峰值小于250 L/min或男性呼气流量峰值小于350 L/min。

具有临床意义的COPD被定义为肺活量测定法定义的COPD（最大呼气第一秒用力呼气量[FEV1]与用力肺活量[FEV1:FVC]<0.70或如果未完成支气管扩张后肺活量测量，则支气管扩张前FEV1:FVC<0.65），并伴有FEV1低于预测值的60%或自述过去12个月内急性呼吸衰竭史呼吸道疾病。

在4325名有足够数据可供分析的患者中（63.0%为女性；平均年龄为61.6岁），44.6%曾吸烟，18.3%报告既往有哮喘诊断或使用吸入呼吸药物，13.2%目前吸烟，10.0%报告至少有1种心血管共病。在110名未确诊、临床意义重大的COPD患者中（4325名患者中有2.5%），53名患者的筛查结果为阳性，敏感性为48.2%，特异性为88.6%。不同阳性筛查阈值的受试者操作曲线下面积为0.81。

研究结果表明，在这一美国初级保健人群中，CAPTURE筛查工具对识别由中度严重气流阻塞或伴有急性呼吸系统疾病史定义的具有临床意义的COPD具有较低的敏感性，但具有较高的特异性。仍需要进一步研究以优化筛查工具的性能，并了解其使用是否影响临床结果。

附：英文原文

Title: Discriminative Accuracy of the CAPTURE Tool for Identifying Chronic Obstructive Pulmonary Disease in US Primary Care Settings

Author: Fernando J. Martinez, MeiLan K. Han, Camden Lopez, Susan Murray, David Mannino, Stacey Anderson, Randall Brown, Rowena Dolor, Nancy Elder, Min Joo, Irfan Khan, Lyndee M. Knox, Catherine Meldrum, Elizabeth Peters, Cathie Spino, Hazel Tapp, Byron Thomashow, Linda Zittleman, Barry Make, Barbara P. Yawn, CAPTURE Study Group, Emily White, Cathy Scott, Megan Urbin, Jeffrey Holtzman, Alicia Morris, Anna Smyth, Stefan Jhagroo, Michelle LoPiccolo, Pete Amari, Claudya Greig, Brandon Holmes, Elisha Malanga, Sergio Martinez, Gretchen McCreary, Cara Pasquale, Linda Walsh, Ruth Tal-Singer, Malin Fagers, Norbert Feigler, Angus Hamblin, Frank Trudo, Erin Tomaszewski, Alberto de la Hoz, Carl Abbott, Shahin Sanjar, Carlos Tafur, Carole Catapano, Kim Gilchrist, Nancy Kline Leidy, Lindsey Amendola, Jose Flores, Grace Ruh, Tammy Harvey, Ashleigh Skipper, Kate Walsh, Lauren Warsocki, Abm Shafayet, Cynthia Pinargotte, Melba Ventuera, Vikash Mandania, Donna Green, Luis Paredas, Erika Barba, Erica Mezzasalma, Lindsey Williams, Jack Westfall, Jen Ancona, Lori Jarell, Megan Kaiser, Christin Sutter, Ranee Chatterjee, Chad Harrell, Taylor Harris, Kimberly Leathers, Beth Mancuso-Mills

Issue&Volume: 2023/02/14

Abstract:

Importance  Chronic obstructive pulmonary disease (COPD) is underdiagnosed in primary care.

Objective  To evaluate the operating characteristics of the CAPTURE (COPD Assessment in Primary Care To Identify Undiagnosed Respiratory Disease and Exacerbation Risk) screening tool for identifying US primary care patients with undiagnosed, clinically significant COPD.

Design, Setting, and Participants  In this cross-sectional study, 4679 primary care patients aged 45 years to 80 years without a prior COPD diagnosis were enrolled by 7 primary care practice–based research networks across the US between October 12, 2018, and April 1, 2022. The CAPTURE questionnaire responses, peak expiratory flow rate, COPD Assessment Test scores, history of acute respiratory illnesses, demographics, and spirometry results were collected.

Exposure  Undiagnosed COPD.

Main Outcomes and Measures  The primary outcome was the CAPTURE tool’s sensitivity and specificity for identifying patients with undiagnosed, clinically significant COPD. The secondary outcomes included the analyses of varying thresholds for defining a positive screening result for clinically significant COPD. A positive screening result was defined as (1) a CAPTURE questionnaire score of 5 or 6 or (2) a questionnaire score of 2, 3, or 4 together with a peak expiratory flow rate of less than 250 L/min for females or less than 350 L/min for males. Clinically significant COPD was defined as spirometry-defined COPD (postbronchodilator ratio of forced expiratory volume in the first second of expiration [FEV1] to forced vital capacity [FEV1:FVC] <0.70 or prebronchodilator FEV1:FVC <0.65 if postbronchodilator spirometry was not completed) combined with either an FEV1 less than 60% of the predicted value or a self-reported history of an acute respiratory illness within the past 12 months.

Results  Of the 4325 patients who had adequate data for analysis (63.0% were women; the mean age was 61.6 years [SD, 9.1 years]), 44.6% had ever smoked cigarettes, 18.3% reported a prior asthma diagnosis or use of inhaled respiratory medications, 13.2% currently smoked cigarettes, and 10.0% reported at least 1 cardiovascular comorbidity. Among the 110 patients (2.5% of 4325) with undiagnosed, clinically significant COPD, 53 had a positive screening result with a sensitivity of 48.2% (95% CI, 38.6%-57.9%) and a specificity of 88.6% (95% CI, 87.6%-89.6%). The area under the receiver operating curve for varying positive screening thresholds was 0.81 (95% CI, 0.77-0.85).

Conclusions and Relevance  Within this US primary care population, the CAPTURE screening tool had a low sensitivity but a high specificity for identifying clinically significant COPD defined by presence of airflow obstruction that is of moderate severity or accompanied by a history of acute respiratory illness. Further research is needed to optimize performance of the screening tool and to understand whether its use affects clinical outcomes.

DOI: 10.1001/jama.2023.0128

Source: https://jamanetwork.com/journals/jama/article-abstract/2801317