5 Simple Questions as Good as Spirometry for Initial Copd Diagnosis

June 3, 2007
Mark L. Fuerst

Internal Medicine World Report, July 2006, Volume 0, Issue 0

An Often Overlooked Disease

SAN DIEGO—Five simple questions about breathlessness, productive cough, change in activity level, smoking history, and age can help determine whether a patient is likely to have chronic obstructive pulmonary disease (COPD), a severely underdiagnosed condition.

The COPD Population Screener (Box) can predict airway obstruction that is not fully reversible and is consistent with COPD. Results of validity analyses support its ability to reliably identify individuals who have the disease. A score of 4 or 5 positive responses will likely indicate a COPD diagnosis.

Such a COPD screening tool “may lead to increased awareness, earlier symptom recognition, and the use of spirometry for accurate diagnosis,” said Fernando Martinez, MD, of the University of Michigan, Ann Arbor, at the American Thoracic Society annual meeting. “Earlier diagnosis of COPD could lead to timely and effective interventions that may result in improved clinical outcomes.”

Dr Martinez and colleagues recruited 697 individuals (aged ≥35 years) who were seeing a participating doctor for routine office visits. In addition to a survey and the history, spirometry measurements were recorded before and after administering the bronchodilator albuterol (AccuNeb, Proventil).

Some 295 persons met expert review criteria for spirometry performance. Spirometry findings showed 113 patients (38%) had COPD; of these, 85% had moderate-to-severe disease, and 15% had mild disease.

Spirometry findings showed that 18 patients (17%) from general practices and 95 patients (50%) from pulmonary practices had airway obstruction consistent with COPD. Of these, 7 patients (38%) from general practices and 17 patients (18%) from pulmonary practices had never been diagnosed with COPD, most of whom (75%) had moderate-to-severe disease.

Dr Martinez foresees the day when a patient can come into a doctor’s office, answer the 5 questions in the waiting room, and have the COPD score ready by the time he or she sees the doctor. “We can’t do spirometry on everyone....Using the tool will lead to less spirometry overall and better diagnosis of COPD,” he said.

The diagnostic questionnaire supports government guidelines by helping determine when physicians should consider spirometry. A National Institutes of Health initiative on COPD aimed at the public is anticipated to be announced this fall. “Dissemination of such a tool in the general population may encourage individuals to discuss their breathing symptoms with a health care provider,” Dr Martinez said.

COPD Screener

1. During the past 4 weeks, how much of the time did you feel short of breath?

None A little Some Most

2. Do you ever cough up any “stuff,” such as mucus or phlegm?

Never Occasionally A few days a month Most days of the week Every day

3. Please select the response to the following statement that best describes you in the past 12 months: I do less than I used to because of my breathing problems.

Strongly disagree Disagree Unsure Agree Strongly agree

4. Have you smoked at least 100 cigarettes in your entire life?

No Yes

5. How old are you?

<50 years 50-59 years 60-69 years ≥70 years