Validation and intra-rater reliability of the CDQ scale for the diagnosis of COPD in Colombia
DOI:
https://doi.org/10.17533/10.17533/udea.iatreia.141Keywords:
Pulmonary Disease, Chronic Obstructive, Pulmonary Disease, Reliability and Validity, SpirometryAbstract
Background: COPD is highly underdiagnosed, thus applying clinical prediction scales such as the COPD Diagnostic Questionnaire (CDQ) helps to address this problem.
Objective: To evaluate the criterion validity and intra-rater reproducibility of the questionnaire CDQ in a Colombian population.
Materials and methods: A prospective cohort study. The reproducibility was assessed with the Kappa statistic and the intraclass correlation coefficient (ICC). Validity was established with the score obtained from the CDQ questionnaire and the spirometry values (FEV1/ FVC <0.7 post B2). The area under the curve of the receiver operating characteristics (ACOR), sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated. A statistically significant p <0.05 was considered.
Results: A total of 1,423 subjects were recruited. The ICC between the two moments of the questionnaire evaluation was 0.781 (95%CI: 0.744-0.813), and a kappa of 0.65 (p <0.001) was found for the scoring systems with low probability of COPD CDQ ≤ 16.5, intermediate probability of CDQ COPD > 16.5 and < 19.5, and high probability of CDQ COPD ≥ 19.6. The ACOR was 0.68 (95%CI: 0.647-0.712), a sensitivity of 9% and a specificity of 44% were obtained for a score ≥16.5, with a PPV of 26% and a NPV of 86%.
Conclusions: The CDQ questionnaire has a regular performance for the diagnosis of COPD with an ACOR similar to other questionnaires, it can be useful in underdiagnosed patients. The optimal cut-off point for this population was 16.5.
Downloads
References
(1) Mirza S, Clay RD, Koslow MA, Scanlon PD. COPD Guidelines: A Review of the 2018 GOLD Report. Mayo Clin Proc. 2018 Oct;93(10):1488-1502. DOI 10.1016/j.mayocp.2018.05.026.
(2) Halbert RJ, Isonaka S, George D, Iqbal A. Interpreting COPD prevalence estimates: what is the true burden of disease? Chest. 2003 May;123(5):1684-92. DOI 10.1378/chest.123.5.1684.
(3) Burney P, Suissa S, Soriano JB, Vollmer WM, Viegi G, Sullivan SD, et al. The pharmacoepidemiology of COPD: recent advances and methodological discussion. Eur Respir J Suppl. 2003 Sep;43:1s-44s.
(4) Llordés M, Jaén A, Almagro P, Heredia JL, Morera J, Soriano JB, Miravitlles M. Prevalence, Risk Factors and Diagnostic Accuracy of COPD Among Smokers in Primary Care. COPD. 2015 Aug;12(4):404-12. DOI 10.3109/15412555.2014.974736.
(5) Menezes AM, Perez-Padilla R, Jardim JR, Muiño A, Lopez MV, Valdivia G, et al. Chronic obstructive pulmonary disease in five Latin American cities (the PLATINO study): a prevalence study. Lancet. 2005 Nov 26;366(9500):1875-81. DOI 10.1016/S0140-6736(05)67632-5.
(6) Lopez Varela MV, Rey A, Casas A, Ramirez A, Moreno D, Schiavi E, et al. Primary care COPD case finding in four latin íntomas countries: The puma study. Am J Respir and Crit Care Med. 2014;189:A2943.
(7) Caballero A, Torres-Duque CA, Jaramillo C, Bolívar F, Sanabria F, Osorio P, et al. Prevalence of COPD in five Colombian cities situated at low, medium, and high altitude (PREPOCOL study). Chest. 2008 Feb;133(2):343-9. DOI 10.1378/chest.07-1361.
(8) Reyes-García A, Torre-Bouscoulet L, Pérez-Padilla R. Controversies and limitations in the diagnosis of chronic obstructive pulmonary disease. Rev Invest Clin. 2019;71(1):28-35. DOI 10.24875/RIC.18002626.
(9) Haroon S, Jordan R, Takwoingi Y, Adab P. Diagnostic accuracy of screening tests for COPD: a systematic review and meta-analysis. BMJ Open. 2015 Oct 8;5(10):e008133. DOI 10.1136/bmjopen-2015-008133.
(10) Mintz ML, Yawn BP, Mannino DM, Donohue JF, Hanania NA, Grellet CA, et al. Prevalence of airway obstruction assessed by lung function questionnaire. Mayo Clin Proc. 2011 May;86(5):375-81. DOI 10.4065/mcp.2010.0787.
(11) Yawn BP, Mapel DW, Mannino DM, Martinez FJ, Donohue JF, Hanania NA, et al. Development of the Lung Function Questionnaire (LFQ) to identify airflow obstruction. Int J Chron Obstruct Pulmon Dis. 2010;5:1-10.
(12) Martinez FJ, Raczek AE, Seifer FD, Conoscenti CS, Curtice TG, D’Eletto T, et al. Development and initial validation of a self-scored COPD Population Screener Questionnaire (COPD-PS). COPD. 2008;5(2):85-95. DOI 10.1080/15412550801940721.
(13) Kotz D, Nelemans P, van Schayck CP, Wesseling GJ. External validation of a COPD diagnostic questionnaire. Eur Respir J 2008;31(2):298–303. DOI 10.1183/09031936.00074307.
(14) Kawayama T, Minakata Y, Matsunaga K, Wesseling GJ. Validation of symptom-based COPD questionnaires in Japanese subjects. Respirology 2008;13:420–6. DOI 10.1111/j.1440-1843.2008.01241.
(15) Stanley AJ, Hasan I, Crockett AJ, van Schayck OC, Zwar NA. Validation of the COPD Diagnostic Questionnaire in an Australian general practice cohort: a cross-sectional study. Prim Care Respir J. 2014 Mar;23(1):92-7. DOI 10.4104/pcrj.2014.00015.
(16) Galindo RM, Pérez MF, Ramírez JP. Diagnóstico de enfermedad pulmonar obstructiva crónica en pacientes con exposición al humo de biomasa [Tesis gradual]. Guatemala: Facultad de ciencias médicas; 2016.
(17) Qaseem A, Wilt TJ, Weinberger SE, Hanania NA, Criner G, van der Molen T, et al. Diagnosis and management of stable chronic obstructive pulmonary disease: a clinical practice guideline update from the American College of Physicians, American College of Chest Physicians, American Thoracic Society, and European Respiratory Society. Ann Intern Med. 2011;155(3):179-91. DOI 10.7326/0003-4819-155-3-201108020-00008.
(18) Obuchowski NA. Sample size calculations in studies of test accuracy. Stat Methods Med Res. 1998 Dec;7(4):371-92. DOI 10.1177/096228029800700405.
(19) Fleiss JL. Statistical methods for rates and proportions, 2ª ed. New York: Wiley; 2000.
(20) Sichletidis L, Spyratos D, Papaioannou M, Chloros D, Tsiotsios A, Tsagaraki V. A combination of the IPAG questionnaire and PiKo-6®️ flow meter is a valuable screening tool for COPD in the primary care setting. Prim Care Respir J. 2011;20:184–9. DOI 10.4104/pcrj.2011.00038.
(21) Frith P, Crockett A, Beilby J, Marshall D, Attewell R, Ratnanesan A. Simplified COPD screening: validation of the PiKo-6®️ in primary care. Prim Care Respir J. 2011;20:190–8. DOI 10.4104/pcrj.2011.00040.
(22) Hu G, Zhou Y, Tian J, Yao W, Li J, Li B, et al. Risk of COPD from exposure to biomass smoke: a metaanalysis. Chest. 2010;138:20-31. DOI 10.1378/chest.08-2114.
(23) Kart L, Akkoyunlu ME, Bayram M, Yakar F, Kutbay Özçelik H, Karaköse F, et al. COPD: An underdiagnosed disease at hospital environment. Wien Klin Wochenschr. 2014;126:73-8. DOI 10.1007/s00508-013-0458-4.
(24) Martinez FJ, Mannino D, Leidy NK, Malley KG, Bacci ED, Barr RG, et al. A New Approach for Identifying Patients with Undiagnosed Chronic Obstructive Pulmonary Disease. Am J Respir Crit Care Med. 2017;195(6):748-56. DOI 10.1164/rccm.201603-0622OC.
(25) Stallberg B, Nokela M, Ehrs PO, Hjemdal P, Jonsson EW. Validation of the clinical COPD Questionnaire (CCQ) in primary care. Health Qual Life Outcomes. 2009;7:26. DOI 10.1186/1477-7525-7-26.
(26) Sundh J, Janson C, Lisspers K, Montgomery S, Stallberg B. Clinical COPD Questionnaire score (CCQ) and mortality. Int J Chron Obstruct Pulmon Dis. 2012;7:833-42. DOI 10.2147/COPD.S38119.
(27) Llordés M, Zurdo E, Jaén Á, Vázquez I, Pastrana L, Miravitlles M. Which is the Best Screening Strategy for COPD among Smokers in Primary Care? COPD. 2017;14:43-51. DOI 19.10.1186/s12931-018-0882-0.
(28) Espinosa de los Monteros MJ, Pena C, Soto Hurtado EJ, Jareno J, Miravitlles M. Variability of respiratory symptoms in severe COPD. Arch Bronconeumol. 2012;48:3-7. DOI 10.1016/j.arbr.2011.07.006.
(29) Van Schayck CP, Halbert RJ, Nordyke RJ, Isonaka S, Maroni J, Nonikov D. Comparison of existing symptom-based questionnaires for identifying COPD in the general practice setting. Respirology. 2005;10:323-33. DOI 10.1111/j.1440-1843.2005.00720.x.
(30) Smid DE, Franssen FME, Houben-Wilke S, Vanfleteren LEGW, Janssen DJA, Wouters EFM, et al. Responsiveness and MCID Estimates for CAT, CCQ, and HADS in Patients With COPD Undergoing Pulmonary Rehabilitation: A Prospective Analysis. J Am Med Dir Assoc. 2017;18:53-8. DOI 10.1016/j.jamda.2016.08.002.
Published
How to Cite
Issue
Section
License
Copyright (c) 2021 Universidad de Antioquia
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Papers published in the journal are available for use under the Creative Commons license, specifically Attribution-NonCommercial-ShareAlike 4.0 International.
The papers must be unpublished and sent exclusively to the Journal Iatreia; the author uploading the contribution is required to submit two fully completed formats: article submission and authorship responsibility.
