Accuracy and economic evaluation of screening tests for undiagnosed COPD among hypertensive individuals in Brazil
Abstract In Brazil, prevalence of diagnosed COPD among adults aged 40 years and over is 16% although over 70% of cases remain undiagnosed. Hypertension is common and well-recorded in primary care, and frequently co-exists with COPD because of common causes such as tobacco smoking, therefore we condu...
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| Format: | Article |
| Language: | English |
| Published: |
Nature Portfolio
2022-12-01
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| Series: | npj Primary Care Respiratory Medicine |
| Online Access: | https://doi.org/10.1038/s41533-022-00303-w |
| _version_ | 1828265884958851072 |
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| author | S. M. Martins A. P. Dickens W. Salibe-Filho A. A. Albuquerque Neto P. Adab A. Enocson B. G. Cooper L. V. A. Sousa A. J. Sitch S. Jowett R. Adams K. K. Cheng C. Chi J. Correia-de-Sousa A. Farley N. Gale K. Jolly M. Maglakelidze T. Maghlakelidze K. Stavrikj A. M. Turner S. Williams R. E. Jordan R. Stelmach |
| author_facet | S. M. Martins A. P. Dickens W. Salibe-Filho A. A. Albuquerque Neto P. Adab A. Enocson B. G. Cooper L. V. A. Sousa A. J. Sitch S. Jowett R. Adams K. K. Cheng C. Chi J. Correia-de-Sousa A. Farley N. Gale K. Jolly M. Maglakelidze T. Maghlakelidze K. Stavrikj A. M. Turner S. Williams R. E. Jordan R. Stelmach |
| author_sort | S. M. Martins |
| collection | DOAJ |
| description | Abstract In Brazil, prevalence of diagnosed COPD among adults aged 40 years and over is 16% although over 70% of cases remain undiagnosed. Hypertension is common and well-recorded in primary care, and frequently co-exists with COPD because of common causes such as tobacco smoking, therefore we conducted a cross-sectional screening test accuracy study in nine Basic Health Units in Brazil, among hypertensive patients aged ≥40 years to identify the optimum screening test/combinations to detect undiagnosed COPD. We compared six index tests (four screening questionnaires, microspirometer and peak flow) against the reference test defined as those below the lower limit of normal (LLN-GLI) on quality diagnostic spirometry, with confirmed COPD at clinical review. Of 1162 participants, 6.8% (n = 79) had clinically confirmed COPD. Peak flow had a higher specificity but lower sensitivity than microspirometry (sensitivity 44.3% [95% CI 33.1, 55.9], specificity 95.5% [95% CI 94.1, 96.6]). SBQ performed well compared to the other questionnaires (sensitivity 75.9% [95% CI 65.0, 84.9], specificity 59.2% [95% CI 56.2, 62.1]). A strategy requiring both SBQ and peak flow to be positive yielded sensitivity of 39.2% (95% CI 28.4, 50.9) and specificity of 97.0% (95% CI 95.7, 97.9). The use of simple screening tests was feasible within the Brazilian primary care setting. The combination of SBQ and peak flow appeared most efficient, when considering performance of the test, cost and ease of use (costing £1690 (5554 R$) with 26.7 cases detected per 1,000 patients). However, the choice of screening tests depends on the clinical setting and availability of resources. ISRCTN registration number: 11377960. |
| first_indexed | 2024-04-13T04:46:00Z |
| format | Article |
| id | doaj.art-6dc3044aaf554352a6361a674c140693 |
| institution | Directory Open Access Journal |
| issn | 2055-1010 |
| language | English |
| last_indexed | 2024-04-13T04:46:00Z |
| publishDate | 2022-12-01 |
| publisher | Nature Portfolio |
| record_format | Article |
| series | npj Primary Care Respiratory Medicine |
| spelling | doaj.art-6dc3044aaf554352a6361a674c1406932022-12-22T03:01:51ZengNature Portfolionpj Primary Care Respiratory Medicine2055-10102022-12-0132111010.1038/s41533-022-00303-wAccuracy and economic evaluation of screening tests for undiagnosed COPD among hypertensive individuals in BrazilS. M. Martins0A. P. Dickens1W. Salibe-Filho2A. A. Albuquerque Neto3P. Adab4A. Enocson5B. G. Cooper6L. V. A. Sousa7A. J. Sitch8S. Jowett9R. Adams10K. K. Cheng11C. Chi12J. Correia-de-Sousa13A. Farley14N. Gale15K. Jolly16M. Maglakelidze17T. Maghlakelidze18K. Stavrikj19A. M. Turner20S. Williams21R. E. Jordan22R. Stelmach23Family Medicine, ABC Medical SchoolInstitute of Applied Health Research, University of BirminghamFamily Medicine, ABC Medical SchoolFaculty of Medicine, Federal University of São PauloInstitute of Applied Health Research, University of BirminghamInstitute of Applied Health Research, University of BirminghamLung Function & Sleep, University Hospitals Birmingham NHS Foundation TrustFamily Medicine, ABC Medical SchoolInstitute of Applied Health Research, University of BirminghamInstitute of Applied Health Research, University of BirminghamInstitute of Applied Health Research, University of BirminghamInstitute of Applied Health Research, University of BirminghamDepartment of General Practice, Peking University First HospitalInternational Primary Care Respiratory GroupInstitute of Applied Health Research, University of BirminghamHealth Services Management Centre, School of Social Policy, College of Social Sciences, University of BirminghamInstitute of Applied Health Research, University of BirminghamGeorgian Respiratory AssociationGeorgian Respiratory AssociationCenter for Family Medicine, Faculty of Medicine, Ss.Cyril and Methodius University in SkopjeInstitute of Applied Health Research, University of BirminghamInternational Primary Care Respiratory GroupInstitute of Applied Health Research, University of BirminghamRespiratory Division, Hospital das Clínicas, Faculdade de Medicina, Universidade de Sao PauloAbstract In Brazil, prevalence of diagnosed COPD among adults aged 40 years and over is 16% although over 70% of cases remain undiagnosed. Hypertension is common and well-recorded in primary care, and frequently co-exists with COPD because of common causes such as tobacco smoking, therefore we conducted a cross-sectional screening test accuracy study in nine Basic Health Units in Brazil, among hypertensive patients aged ≥40 years to identify the optimum screening test/combinations to detect undiagnosed COPD. We compared six index tests (four screening questionnaires, microspirometer and peak flow) against the reference test defined as those below the lower limit of normal (LLN-GLI) on quality diagnostic spirometry, with confirmed COPD at clinical review. Of 1162 participants, 6.8% (n = 79) had clinically confirmed COPD. Peak flow had a higher specificity but lower sensitivity than microspirometry (sensitivity 44.3% [95% CI 33.1, 55.9], specificity 95.5% [95% CI 94.1, 96.6]). SBQ performed well compared to the other questionnaires (sensitivity 75.9% [95% CI 65.0, 84.9], specificity 59.2% [95% CI 56.2, 62.1]). A strategy requiring both SBQ and peak flow to be positive yielded sensitivity of 39.2% (95% CI 28.4, 50.9) and specificity of 97.0% (95% CI 95.7, 97.9). The use of simple screening tests was feasible within the Brazilian primary care setting. The combination of SBQ and peak flow appeared most efficient, when considering performance of the test, cost and ease of use (costing £1690 (5554 R$) with 26.7 cases detected per 1,000 patients). However, the choice of screening tests depends on the clinical setting and availability of resources. ISRCTN registration number: 11377960.https://doi.org/10.1038/s41533-022-00303-w |
| spellingShingle | S. M. Martins A. P. Dickens W. Salibe-Filho A. A. Albuquerque Neto P. Adab A. Enocson B. G. Cooper L. V. A. Sousa A. J. Sitch S. Jowett R. Adams K. K. Cheng C. Chi J. Correia-de-Sousa A. Farley N. Gale K. Jolly M. Maglakelidze T. Maghlakelidze K. Stavrikj A. M. Turner S. Williams R. E. Jordan R. Stelmach Accuracy and economic evaluation of screening tests for undiagnosed COPD among hypertensive individuals in Brazil npj Primary Care Respiratory Medicine |
| title | Accuracy and economic evaluation of screening tests for undiagnosed COPD among hypertensive individuals in Brazil |
| title_full | Accuracy and economic evaluation of screening tests for undiagnosed COPD among hypertensive individuals in Brazil |
| title_fullStr | Accuracy and economic evaluation of screening tests for undiagnosed COPD among hypertensive individuals in Brazil |
| title_full_unstemmed | Accuracy and economic evaluation of screening tests for undiagnosed COPD among hypertensive individuals in Brazil |
| title_short | Accuracy and economic evaluation of screening tests for undiagnosed COPD among hypertensive individuals in Brazil |
| title_sort | accuracy and economic evaluation of screening tests for undiagnosed copd among hypertensive individuals in brazil |
| url | https://doi.org/10.1038/s41533-022-00303-w |
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