Accuracy and economic evaluation of different screening tests and their combinations for undiagnosed COPD among people with hypertension in Brazil

Sonia M. Martins, Andy Dickens, W Salibe-Filho , AA Albuquerque Neto , Peymane Adab, Alexandra Enocson, BG Cooper, LVA Sousa, Alice Sitch, Sue Jowett, Rachel Adams, KK Cheng, C Chi, Jaime Correia-de-Sousa, Amanda Farley, Nicola Gale, Kate Jolly, M Maglakelidze, T Maghlakelidze, Katarina StavrikjAlice Turner, S. Williams, Rachel Jordan, R Stelmach

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Abstract

In Brazil, prevalence of diagnosed COPD among adults aged 40 years and over is 16% although over 70% of cases remain undiagnosed. Hypertension is common and well-recorded in primary care, and frequently co-exists with COPD because of common causes such as tobacco smoking, therefore we conducted a cross-sectional screening test accuracy study in nine Basic Health Units in Brazil, among hypertensive patients aged ≥40 years to identify the optimum screening test/combinations to detect undiagnosed COPD. We compared six index tests (four screening questionnaires, microspirometer and peak flow) against the reference test defined as those below the lower limit of normal (LLN-GLI) on quality diagnostic spirometry, with confirmed COPD at clinical review. Of 1162 participants, 6.8% (n = 79) had clinically confirmed COPD. Peak flow had a higher specificity but lower sensitivity than microspirometry (sensitivity 44.3% [95% CI 33.1, 55.9], specificity 95.5% [95% CI 94.1, 96.6]). SBQ performed well compared to the other questionnaires (sensitivity 75.9% [95% CI 65.0, 84.9], specificity 59.2% [95% CI 56.2, 62.1]). A strategy requiring both SBQ and peak flow to be positive yielded sensitivity of 39.2% (95% CI 28.4, 50.9) and specificity of 97.0% (95% CI 95.7, 97.9). The use of simple screening tests was feasible within the Brazilian primary care setting. The combination of SBQ and peak flow appeared most efficient, when considering performance of the test, cost and ease of use (costing £1690 (5554 R$) with 26.7 cases detected per 1,000 patients). However, the choice of screening tests depends on the clinical setting and availability of resources.
Original languageEnglish
Article number55
JournalNPJ Primary Care Respiratory Medicine
Volume32
DOIs
Publication statusPublished - 13 Dec 2022

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