B44-02 Guiding COPD Diagnosis in Primary Care: A Systematic Review of Case-finding Questionnaires

Abstract Rationale COPD is a prevalent, underdiagnosed condition that relies on spirometry for a diagnosis. Controversy with screening spirometry has led to case finding questionnaires for identification of symptomatic or high-risk individuals for diagnostic pulmonary testing. COPD case finding questionnaires have been developed and validated against spirometry in various populations around the world. In this systematic review, the aim is to evaluate the operating characteristics of case finding questionnaires concerning incident diagnosis of COPD in primary healthcare settings and expand upon previous systematic reviews on COPD case finding tools. Methods This systematic review followed the principles of Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The following databases were searched; Ovid Medline, Scopus, and EBSCO CINAHL using Medical Subject Headings (MeSH) terms: COPD, diagnosis, questionnaire, and primary care. To be included, studies were reported in English and screened undiagnosed patients using a COPD case finding questionnaire in a primary healthcare setting with subsequent performance of spirometry. We excluded studies that did not include sensitivity and specificity or used a randomized sample population. Data collected included population, sample size, setting, questionnaire, cut off value, sensitivity, specificity, and area under the curve. Results The systematic search identified 17,237 publications with 12,936 duplicates. 8,088 publications were identified with 29 publications fulfilling criteria for review. Articles included in the review spanned from May 2006 to March 2025. Studies were conducted in 19 countries, most commonly China (n = 6), Australia (n = 4) and United States (n = 3). Sample populations ranged from 150- 3537 individuals. Nineteen unique case finding questionnaires were identified with the most frequent questionnaires being the COPD Diagnostic Questionnaire (CDQ) (n = 11), COPD Population Screener (COPD-PS) (n = 8) and PUMA (n = 4). Cut-off values were identified and associated with performance of spirometry. CDQ was the highest performing questionnaire with a sensitivity range of 50.6- 97.9 % and a specificity range of 13.1- 95 %. The COPD-PS range of sensitivity was 48.9- 93.6 % and a specificity range of 46- 90 %. The PUMA questionnaire sensitivity range was 76.3- 91.2 % and specificity range was 37.6- 69.3 %. Cut off values for CDQ ≥ 16.5, COPD-PS ≥ 5 and PUMA ≥ 5 were associated with higher likelihood of COPD. Conclusion Active case finding questionnaires, CDQ and COPD-PS, are effective tools that can be used as a screening test to facilitate performance of diagnostic spirometry in symptomatic patients. This abstract is funded by: None