Developing a Diagnostic Score for COPD in Sisaket Hospital
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Abstract
Background: A correct diagnosis of chronic obstructive pulmonary disease (COPD) is critical to treatment. According to the criteria for the diagnosis of COPD, it is necessary to rely on the results of spirometry, but in Thailand there are limitations in spirometry as such tests cannot be performed in every hospital. Peak flow meters can be made easier and can be done in every hospital.
Objective: To develop a scoring tool for the diagnosis of COPD based on questionnaires and peak expiratory flow rate (PEFR) of patients.
Methods: This study was a cross-sectional analytical study with prospective data collection in which participants were assessed by questionnaires. PEFR and spirometry were examined. The data were then used to determine the predictor of COPD diagnosis by using multivariable logistic regression on the variables that were important for the diagnosis of COPD, and then used the lowest coefficient to create a diagnostic score. Then, the score was used to divide participants into two groups: those with COPD and those without COPD. The sensitivity, specificity, positive predictive value, and negative predictive value were then determined.
Results: A total of 196 patients were enrolled, and 141 patients completed the study. Thirty-nine people (27.7%) were diagnosed with COPD, 100 (70.9%) with asthma, and 2 (1.4%) with bronchiectasis. The predictors that are important for the diagnosis of COPD are: age at onset of respiratory symptoms ≥40 years, past history of pulmonary tuberculosis, history of smoking, and a PEFR less than 80% of the norm for the same gender, age, and height (<80% predicted). When making a diagnosis of COPD, if the total score from the above predictors was ≥11, the sensitivity was 100.0% (91.0-100.0), the specificity was 66.7% (56.6-75.7), the positive predictive value was 53.4% (41.4-65.2), and the negative predictive value was 100.0% (94.7-100.0)
Conclusions: Using the questionnaire-based history score together with a PEFR <80% predicted is a highly sensitive tool for diagnosing COPD. This is useful in helping with the screening of such disease in patients with respiratory symptoms. Especially in community hospitals that have limitations in spirometry.
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