Diagnostic value of screening tests: Questionnaires, Peak flow-meter and Microspirometer in early detection of individuals with chronic obstructive pulmonary disease in primary health care in North Macedonia

Katerina Kovachevikj, Sashka Janevska, Marta Tundzeva, Azra Gicic, Ruzica Angeleska, Katarina Stavrikj, Irena Kondova -Topuzovska

Keywords: Chronic obstructive pulmonary disease, primary health care, questionnaires, screening.

Background:

Macedonia has high smoking prevalence of 31/47.1% in female/male population older of 16 years. GPs have insufficient familiarity with diagnosing, treating and preventing COPD. The luck of specialists’ pulmonologists who are doing diagnosis and management of COPD patients, result in underdiagnosed COPD.

Research questions:

Which screening test or combination of screening tests for chronic obstructive pulmonary disease (COPD) can be recommended for detecting undiagnosed COPD in primary health care in patients ≥ 40 years old, compared to standard test spirometry?

Method:

A one year cross-sectional study will be run in primary care setting in Skopje. 200 participants aged ≥ 40 to 75 years who came to GP for examination without respiratory symptoms and have signed an informed consent will be included. The study include six index tests that will be performed in GP’s practice - 4 questionnaires for COPD screening: CDQ, CAPTURE, COPD SQ, SBQ and 2 tests for air flow measurement: Peak flow-meter and microspirometry. The results of the index tests will be compared with the result of the reference test-spirometry which will be performed at secondary health care level. A confirmed case will be defined as a patient with FEV1/FVC <0.70 on the reference test.

Results:

The primary outcome is to determine the diagnostic value of screening tests (individually or in combination with other screening test) : questionnaires, Peak flow-meter and microspirometry in early detection of COPD in PHC. The secondary outcome is to develop an effective strategy at primary care level in diagnosing COPD.

Conclusions:

We expect to detect most effective screening test or a combination of screening tests for identifying undiagnosed COPD in PHC.

Points for discussion:

Which cut off score should be used for PEF to indicate a positive test?

Should we include evaluation of Cost-effectiveness of most effective screening strategy?