作者
Fernando J. Martínez,MeiLan K. Han,Camden L. Lopez,Susan Murray,David M. Mannino,Stacey E. Anderson,Randall W. Brown,Rowena J Dolor,Nancy Elder,Min J. Joo,Irfan Khan,Lyndee Knox,Catherine A. Meldrum,Elizabeth Peters,Cathie Spino,Hazel Tapp,David M. Mannino,Linda Zittleman,Barry J. Make,Barbara P. Yawn,Emily E. White,Cathy Scott,M. A. Urbin,Jordan L. Holtzman,Alicia Morris,Anna Smyth,Stefan Jhagroo,Matteo C. LoPiccolo,Pete Amari,Claudya Greig,Brandon B. Holmes,Elisha Malanga,Sergio Martinez,Gretchen McCreary,C.B. Pasquale,Linda Walsh,Ruth Tal‐Singer,Malin Fagerås,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,José M. Flores,Grace Ruh,Tim Harvey,Ashleigh Skipper,Kate Walsh,Lauren Warsocki,Abm Shafayet,Cynthia Pinargotte,Melba Ventuera,Vikash Mandania,Donna Green,Luis Paredas,E I 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,Michael Mangum,Nikita Shah,Beltrán León,Matthew Leon,Patty Dionicio,Lindsay Shade,R Beasley,Andrea Price,Cody Oliver,C.T. Flynn,S D Greenberg,Lindsay Lowe,Laura A. McAllister,Rina Leonidas,Katherine O’Hare,Kelsey Strout,Jérémy Thomas,Lyle J. Fagnan,Xaviera Martinez-Armenta,Lindsay Shankle,Martha Snow,Valeria Vazquez-Trejo,Lisa Tannikula,Aaron Leifer,Jonathan Radosta,Kyungran Shim,Christina E. Wells,Désirée García,Samantha Madrid,E. Pacheco,Lucía Romo,Sara Nora Ross,Eric J. Velazquez,Natasha Brown,Gordon R. Bernard,Deborah R. Barnbaum,João A. de Andrade,Daren Knoel,Peter K. Lindenauer,André Rogatko,Marinella Temprosa
摘要
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 [FEV 1 ] to forced vital capacity [FEV 1 :FVC] <0.70 or prebronchodilator FEV 1 :FVC <0.65 if postbronchodilator spirometry was not completed) combined with either an FEV 1 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.