Performance and Clinical Utility of Various Chronic Obstructive Pulmonary Disease Case-Finding Tools

Chiung Zuei Chen, Chau Chyun Sheu, Shih Lung Cheng, Hao Chien Wang, Meng Chih Lin, Wu Huei Hsu, Kang Yun Lee, Diahn Warng Perng, Hen I. Lin, Ming Shian Lin, Sheng Hao Lin, Jong Rung Tsai, Chin Chou Wang, Cheng Yi Wang, Tsung Ming Yang, Ching Lung Liu, Tsai Yu Wang, Ching Hsiung Lin

Research output: Contribution to journalArticlepeer-review

2 Citations (Scopus)


Background and Aim: Chronic obstructive pulmonary disease (COPD) is frequently underdiagnosed because of the unavailability of spirometers, especially in resource-limited outpatient settings. This study provides real-world evidence to identify optimal approaches for COPD case finding in outpatient settings. Methods: This retrospective study enrolled individuals who were at risk of COPD (age ≥40 years, ≥10 pack-years, and ≥1 respiratory symptom). Eligible participants were examined using various COPD case-finding tools, namely the COPD Population Screener (COPD-PS) questionnaire, a COPD prediction (PCOPD) model, and a microspirometer, Spirobank Smart; subsequently, the participants underwent confirmatory spirometry. The definition and confirmation of COPD were based on conventional spirometry. Receiver operating characteristic curve (ROC), area under the curve (AUC), and decision curve analyses were conducted, and a clinical impact curve was constructed. Results: In total, 385 participants took part in the study [284 without COPD (73.77%) and 101 with COPD (26.23%)]. The microspirometer exhibited a higher AUC value than did the COPD-PS questionnaire and the PCOPD model. The AUC for microspirometry was 0.908 (95% confidence interval [CI] = 0.87-0.95), that for the PCOPD model was 0.788 (95% CI = 0.74-0.84), and that for the COPD-PS questionnaire was 0.726 (95% CI = 0.67-0.78). Decision and clinical impact curve analyses revealed that a microspirometry-derived FEV1/FVC ratio of <74% had superior clinical utility to the other measurement tools. Conclusion: The PCOPD model and COPD-PS questionnaire were useful for identifying symptomatic patients likely to have COPD, but microspirometry was more accurate and had higher clinical utility. This study provides real-world evidence to identify optimal practices for COPD case finding; such practices ensure that physicians have convenient access to up-to-date evidence when they encounter a symptomatic patient likely to have COPD.

Original languageEnglish
Pages (from-to)3405-3415
Number of pages11
JournalInternational journal of chronic obstructive pulmonary disease
Publication statusPublished - Jan 1 2021


  • COPD
  • COPD case-finding
  • COPD-PS questionnaire
  • microspirometry
  • PCOPD model
  • spirometry

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Health Policy
  • Public Health, Environmental and Occupational Health


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