A Novel Case-Finding Instrument for Chronic Obstructive Pulmonary Disease in Low- and Middle-Income Country Settings
Trishul Siddharthan,1,2 Adaeze C Wosu,2,3 Suzanne L Pollard,1,2 Shakir Hossen,1,2 Patricia Alupo,4,5 Timothy Shade,1,2 Robert Kalyesubula,4 Shumonta Quaderi,6 Robert A Wise,1 John R Hurst,6 Bruce Kirenga,4,5 William Checkley1,2 On behalf of LiNK Cohort Study Investigators1Division of Pulmonary and C...
| Main Authors: | , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Dove Medical Press
2020-11-01
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| Series: | International Journal of COPD |
| Subjects: | |
| Online Access: | https://www.dovepress.com/a-novel-case-finding-instrument-for-chronic-obstructive-pulmonary-dise-peer-reviewed-article-COPD |
| _version_ | 1819169737338257408 |
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| author | Siddharthan T Wosu AC Pollard SL Hossen S Alupo P Shade T Kalyesubula R Quaderi S Wise RA Hurst JR Kirenga B Checkley W |
| author_facet | Siddharthan T Wosu AC Pollard SL Hossen S Alupo P Shade T Kalyesubula R Quaderi S Wise RA Hurst JR Kirenga B Checkley W |
| author_sort | Siddharthan T |
| collection | DOAJ |
| description | Trishul Siddharthan,1,2 Adaeze C Wosu,2,3 Suzanne L Pollard,1,2 Shakir Hossen,1,2 Patricia Alupo,4,5 Timothy Shade,1,2 Robert Kalyesubula,4 Shumonta Quaderi,6 Robert A Wise,1 John R Hurst,6 Bruce Kirenga,4,5 William Checkley1,2 On behalf of LiNK Cohort Study Investigators1Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, MD, USA; 2Center for Global Non-Communicable Disease Research and Training, Johns Hopkins University, Baltimore, MD, USA; 3Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA; 4School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda; 5Makerere Lung Institute, Makerere University, Kampala, Uganda; 6UCL Respiratory, University College London, London, UKCorrespondence: William CheckleyDivision of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, 1800 Orleans Ave Suite 9121, Baltimore, MD 21287, USATel +1 443-287-4587Email wcheckl1@jhmi.eduBackground: Low- and middle-income countries (LMICs) account for > 90% of deaths and illness episodes related to COPD; however, this condition is commonly underdiagnosed in these settings. Case-finding instruments for COPD may improve diagnosis and identify individuals that need treatment, but few have been validated in resource-limited settings.Methods: We conducted a population-based cross-sectional study in Uganda to assess the diagnostic accuracy of a respiratory symptom, exposure and functional questionnaire in combination with peak expiratory flow for COPD diagnosis using post-bronchodilator FEV1/FVC z-score below the 5th percentile as the gold standard. We included locally relevant exposure questions and statistical learning techniques to identify the most important risk factors for COPD. We used 80% of the data to develop the case-finding instrument and validated it in the remaining 20%. We evaluated for calibration and discrimination using standard approaches. The final score, COLA (COPD in LMICs Assessment), included seven questions, age and pre-bronchodilator peak expiratory flow.Results: We analyzed data from 1,173 participants (average age 47 years, 46.9% male, 4.5% with COPD) with acceptable and reproducible spirometry. The seven questions yielded a cross-validated area-under-the-curve [AUC] of 0.68 (95% CI 0.61– 0.75) with higher scores conferring greater odds of COPD. The inclusion of peak expiratory flow and age improved prediction in a validation sample (AUC=0.83, 95% CI 0.78– 0.88) with a positive predictive value of 50% and a negative predictive value of 96%. The final instrument (COLA) included seven questions, age and pre-bronchodilator peak expiratory flow.Conclusion: COLA predicted COPD in urban and rural settings in Uganda has high calibration and discrimination, and could serve as a simple, low-cost screening tool in resource-limited settings.Keywords: low- and middle-income countries, COPD, COLA, respiratory symptom |
| first_indexed | 2024-12-22T19:24:15Z |
| format | Article |
| id | doaj.art-3f4f08dad8014289b1913d9310803379 |
| institution | Directory Open Access Journal |
| issn | 1178-2005 |
| language | English |
| last_indexed | 2024-12-22T19:24:15Z |
| publishDate | 2020-11-01 |
| publisher | Dove Medical Press |
| record_format | Article |
| series | International Journal of COPD |
| spelling | doaj.art-3f4f08dad8014289b1913d93108033792022-12-21T18:15:18ZengDove Medical PressInternational Journal of COPD1178-20052020-11-01Volume 152769277758883A Novel Case-Finding Instrument for Chronic Obstructive Pulmonary Disease in Low- and Middle-Income Country SettingsSiddharthan TWosu ACPollard SLHossen SAlupo PShade TKalyesubula RQuaderi SWise RAHurst JRKirenga BCheckley WTrishul Siddharthan,1,2 Adaeze C Wosu,2,3 Suzanne L Pollard,1,2 Shakir Hossen,1,2 Patricia Alupo,4,5 Timothy Shade,1,2 Robert Kalyesubula,4 Shumonta Quaderi,6 Robert A Wise,1 John R Hurst,6 Bruce Kirenga,4,5 William Checkley1,2 On behalf of LiNK Cohort Study Investigators1Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, MD, USA; 2Center for Global Non-Communicable Disease Research and Training, Johns Hopkins University, Baltimore, MD, USA; 3Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA; 4School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda; 5Makerere Lung Institute, Makerere University, Kampala, Uganda; 6UCL Respiratory, University College London, London, UKCorrespondence: William CheckleyDivision of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, 1800 Orleans Ave Suite 9121, Baltimore, MD 21287, USATel +1 443-287-4587Email wcheckl1@jhmi.eduBackground: Low- and middle-income countries (LMICs) account for > 90% of deaths and illness episodes related to COPD; however, this condition is commonly underdiagnosed in these settings. Case-finding instruments for COPD may improve diagnosis and identify individuals that need treatment, but few have been validated in resource-limited settings.Methods: We conducted a population-based cross-sectional study in Uganda to assess the diagnostic accuracy of a respiratory symptom, exposure and functional questionnaire in combination with peak expiratory flow for COPD diagnosis using post-bronchodilator FEV1/FVC z-score below the 5th percentile as the gold standard. We included locally relevant exposure questions and statistical learning techniques to identify the most important risk factors for COPD. We used 80% of the data to develop the case-finding instrument and validated it in the remaining 20%. We evaluated for calibration and discrimination using standard approaches. The final score, COLA (COPD in LMICs Assessment), included seven questions, age and pre-bronchodilator peak expiratory flow.Results: We analyzed data from 1,173 participants (average age 47 years, 46.9% male, 4.5% with COPD) with acceptable and reproducible spirometry. The seven questions yielded a cross-validated area-under-the-curve [AUC] of 0.68 (95% CI 0.61– 0.75) with higher scores conferring greater odds of COPD. The inclusion of peak expiratory flow and age improved prediction in a validation sample (AUC=0.83, 95% CI 0.78– 0.88) with a positive predictive value of 50% and a negative predictive value of 96%. The final instrument (COLA) included seven questions, age and pre-bronchodilator peak expiratory flow.Conclusion: COLA predicted COPD in urban and rural settings in Uganda has high calibration and discrimination, and could serve as a simple, low-cost screening tool in resource-limited settings.Keywords: low- and middle-income countries, COPD, COLA, respiratory symptomhttps://www.dovepress.com/a-novel-case-finding-instrument-for-chronic-obstructive-pulmonary-dise-peer-reviewed-article-COPDcopdcase-findinglow and middle income countries |
| spellingShingle | Siddharthan T Wosu AC Pollard SL Hossen S Alupo P Shade T Kalyesubula R Quaderi S Wise RA Hurst JR Kirenga B Checkley W A Novel Case-Finding Instrument for Chronic Obstructive Pulmonary Disease in Low- and Middle-Income Country Settings International Journal of COPD copd case-finding low and middle income countries |
| title | A Novel Case-Finding Instrument for Chronic Obstructive Pulmonary Disease in Low- and Middle-Income Country Settings |
| title_full | A Novel Case-Finding Instrument for Chronic Obstructive Pulmonary Disease in Low- and Middle-Income Country Settings |
| title_fullStr | A Novel Case-Finding Instrument for Chronic Obstructive Pulmonary Disease in Low- and Middle-Income Country Settings |
| title_full_unstemmed | A Novel Case-Finding Instrument for Chronic Obstructive Pulmonary Disease in Low- and Middle-Income Country Settings |
| title_short | A Novel Case-Finding Instrument for Chronic Obstructive Pulmonary Disease in Low- and Middle-Income Country Settings |
| title_sort | novel case finding instrument for chronic obstructive pulmonary disease in low and middle income country settings |
| topic | copd case-finding low and middle income countries |
| url | https://www.dovepress.com/a-novel-case-finding-instrument-for-chronic-obstructive-pulmonary-dise-peer-reviewed-article-COPD |
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