Validation of the COPD Diagnostic Questionnaire in an Australian general practice cohort: a cross-sectional study

The gold standard for the diagnosis of chronic obstructive pulmonary disease (COPD) is spirometry, but there are barriers to its use in primary care. To externally validate the COPD Diagnostic Questionnaire (CDQ) as a diagnostic tool in patients at increased risk in Australian general practice and t...

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Bibliographic Details
Published inPrimary care respiratory journal Vol. 23; no. 1; pp. 92 - 97
Main Authors Stanley, Anthony J, Hasan, Iqbal, Crockett, Alan J, van Schayck, Onno C P, Zwar, Nicholas A
Format Journal Article
LanguageEnglish
Published England Nature Publishing Group 01.03.2014
Subjects
Adult
Aged
Australia
Cross-Sectional Studies
Female
General Practice
Humans
Male
Middle Aged
Pulmonary Disease, Chronic Obstructive - diagnosis
Research Paper
Spirometry
Surveys and Questionnaires
Australia
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Summary:The gold standard for the diagnosis of chronic obstructive pulmonary disease (COPD) is spirometry, but there are barriers to its use in primary care. To externally validate the COPD Diagnostic Questionnaire (CDQ) as a diagnostic tool in patients at increased risk in Australian general practice and to compare its performance with other CDQ validation studies. Patients were recruited from 36 general practices in Sydney, Australia. Former or current smokers aged 40-85 years with no prior COPD diagnosis were invited to a case-finding appointment with the practice nurse. The CDQ was collected and pre- and postbronchodilator spirometry was performed. Cases for whom complete CDQ data were present and the spirometry met quality standards were analysed. Of 1,631 patients who attended case-finding recruitment, 1,054 (65%) could be analysed. Spirometry showed 13% had COPD. The ability of the CDQ to discriminate between patients with and without COPD was fair, represented by the area under the receiver operating characteristic curve of 0.713. With a CDQ cut-off point value of 16.5 the sensitivity was 80% and specificity 47% and, at a cut-off point value of 19.5, the sensitivity was 63% and specificity 70%. The CDQ did not discriminate between patients with and without COPD accurately enough to use as a diagnostic tool in patients at increased risk of COPD in Australian general practice. Further research is needed on the value of the CDQ as a tool for selecting patients for spirometry.
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The original trial on which this study was based was conceived by NAZ, Dr Jeremy Bunker and Professor Guy Marks and all authors contributed to this study's design, either through the original trial or the current study. OCPvS advised on the design of the CDQ. AJC designed the spirometry toolkit for diagnosis of COPD and performed quality assessment of the spirometry. AJS was the primary author and performed the bulk of the statistical analysis, aided by IH. All authors contributed to and approved the final version of the manuscript.
ISSN:1471-4418
1475-1534
1475-1534
DOI:10.4104/pcrj.2014.00015