Comparison of the COPD population screener and international primary care airway group questionnaires in a general japanese population: The hisayama study

Background: The incidence of chronic obstructive pulmonary disease (COPD) is increasing worldwide. In Japan and other countries, epidemiological studies have found that many patients with COPD are underdiagnosed and untreated, and thus, early detection and treatment of COPD has been emphasized. Screening questionnaires may have utility in the initial detection of COPD. Objective: This study aimed to validate and compare the COPD Population Screener (COPD-PS) and the International Primary Care Airway Group (IPAG) questionnaires in a general Japanese population. Patients and methods: Eligible subjects 40 years of age and older living in the town of Hisayama were solicited to participate in a health checkup in 2012. All subjects 40-79 years of age without physician-diagnosed asthma or lung resection were recruited, and 2,336 subjects who fully completed both questionnaires and who had valid spirometry measurements were analyzed. Persistent airflow obstruction (AO) was defined by a postbronchodilator forced expiratory volume in 1 second/forced vital capacity < 70. Receiver operating characteristic curves, net reclassification improvement, and integrated discrimination improvement were used to examine the ability of the COPD-PS and IPAG questionnaires to discriminate between subjects with and without AO. Results: The overall area under the receiver operating characteristic curve for the COPD-PS questionnaire was 0.747 (95% confidence interval [CI], 0.707-0.788) and for the IPAG was 0.775 (95% CI, 0.735-0.816), with no significant difference (P=0.09). The net reclassification improvement and integrated discrimination improvement were −0.107 (95% CI, −0.273-0.058; P=0.203) and −0.014 (95% CI, −0.033-0.006; P=0.182), respectively. Conclusion: The five-item COPD-PS questionnaire was comparable to the eight-item IPAG for discriminating between subjects with and without AO. The COPD-PS is a simple and useful screening questionnaire for persistent AO.