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      Can CAPTURE be used to identify undiagnosed patients with mild-to-moderate COPD likely to benefit from treatment?

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          Abstract

          Background

          COPD Assessment in Primary Care To Identify Undiagnosed Respiratory Disease and Exacerbation Risk (CAPTURE™) uses five questions and peak expiratory flow (PEF) thresholds (males ≤350 L/min; females ≤250 L/min) to identify patients with a forced expiratory volume in 1 second (FEV 1)/forced vital capacity (FVC) <0.70 and FEV 1 <60% predicted or exacerbation risk requiring further evaluation for COPD. This study tested CAPTURE’s ability to identify symptomatic patients with mild-to-moderate COPD (FEV 1 60%–80% predicted) who may also benefit from diagnosis and treatment.

          Methods

          Data from the CAPTURE development study were used to test its sensitivity (SN) and specificity (SP) differentiating mild-to-moderate COPD (n=73) from no COPD (n=87). SN and SP for differentiating all COPD cases (mild to severe; n=259) from those without COPD (n=87) were also estimated. The modified Medical Research Council (mMRC) dyspnea scale and COPD Assessment Test (CAT™) were used to evaluate symptoms and health status. Clinical Trial Registration: NCT01880177, https://ClinicalTrials.gov/ct2/show/NCT01880177?term=NCT01880177&rank=1.

          Results

          Mean age (+SD): 61 (+10.5) years; 41% male. COPD: FEV 1/FVC=0.60 (+0.1), FEV 1% predicted=74% (+12.4). SN and SP for differentiating mild-to-moderate and non-COPD patients (n=160): Questionnaire: 83.6%, 67.8%; PEF (≤450 L/min; ≤350 L/min): 83.6%, 66.7%; CAPTURE (Questionnaire+PEF): 71.2%, 83.9%. COPD patients whose CAPTURE results suggested that diagnostic evaluation was warranted (n=52) were more likely to be symptomatic than patients whose results did not (n=21) (mMRC >2: 37% vs 5%, p<0.01; CAT>10: 86% vs 57%, p<0.01). CAPTURE differentiated COPD from no COPD (n=346): SN: 88.0%, SP: 83.9%.

          Conclusion

          CAPTURE (450/350) may be useful for identifying symptomatic patients with mild-to-moderate airflow obstruction in need of diagnostic evaluation for COPD.

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          Most cited references 15

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          John LIZARS. Centenary of a forgotten pioneer of the surgery of trigeminal neuralgia.

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            Screening for Chronic Obstructive Pulmonary Disease: US Preventive Services Task Force Recommendation Statement.

            About 14% of US adults aged 40 to 79 years have chronic obstructive pulmonary disease (COPD), and it is the third leading cause of death in the United States. Persons with severe COPD are often unable to participate in normal physical activity due to deterioration of lung function.
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              Spirometry utilization for COPD: how do we measure up?

              COPD is a significant cause of morbidity and mortality. Guidelines recommend the confirmation of a COPD diagnosis with spirometry. Limited evidence exists, however, documenting the frequency of spirometry use in clinical practice. The National Committee for Quality Assurance recruited five health plans to determine the proportion of patients >/= 40 years old with a new diagnosis of COPD who had received spirometry during the interval starting 720 days prior to diagnosis and ending 180 days after diagnosis. Patients were identified via International Classification of Diseases, Ninth Revision diagnostic codes for encounters during the period July 1, 2002, through June 30, 2003. For each patient, the participating plans provided patient demographic and claims data from administrative data systems. Participating health plans covered 1,597,749 members with a total of 5,039 eligible COPD patients identified. Patients in the 40 to 64 age range had the highest percentage of new COPD diagnoses. Women were also slightly more likely to undergo spirometry (33.5% vs 29.4%, p = 0.001). Approximately 32% of patients with a new diagnosis of COPD had undergone spirometry in the specified interval. Spirometry frequency was lowest in older patients, with the lowest frequency in those >/= 75 years old. Our study suggests that approximately 32% of a broad range of patients with a new COPD diagnosis had undergone spirometry within the previous 2 years to 6 months following diagnosis. In addition, spirometric testing appeared to decrease with increasing age. As opposed to a prior report, women were not less likely to have undergone spirometry. This study shows that spirometry is infrequently used in clinical practice for diagnosis of COPD and suggests opportunities for practice improvement.
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                Author and article information

                Journal
                Int J Chron Obstruct Pulmon Dis
                Int J Chron Obstruct Pulmon Dis
                International Journal of COPD
                International Journal of Chronic Obstructive Pulmonary Disease
                Dove Medical Press
                1176-9106
                1178-2005
                2018
                13 June 2018
                : 13
                : 1901-1912
                Affiliations
                [1 ]Evidera, Patient-Centered Research, Bethesda, MD, USA
                [2 ]Weill Cornell Medicine, Joan & Sanford Weill Department of Medicine, New York, NY, USA
                [3 ]University of Kentucky, Preventive Medicine & Environmental Health, Lexington, KY, USA
                [4 ]University of Michigan, Division of Pulmonary & Critical Care Medicine, Ann Arbor, MI, USA
                [5 ]Evidera, Patient-Centered Research, Seattle, WA, USA
                [6 ]University of Michigan, Department of Health Behavior & Health Education, School of Public Health, Ann Arbor, MI, USA
                [7 ]University of Nebraska Medical Center College of Nursing, Omaha, NE, USA
                [8 ]National Jewish Health, Department of Medicine, Division of Pulmonary, Critical Care & Sleep Medicine, Denver, CO, USA
                [9 ]Columbia University Medical Center, Division of Pulmonary, Allergy, & Critical Care, New York, NY, USA
                [10 ]AstraZeneca, IMED Biotech Unit, Cambridge, UK & University of Nebraska Medical Center, Department of Medicine, Omaha, NE, USA
                [11 ]University of Minnesota, Department of Family & Community Health, Minneapolis, MN & COPD Foundation, Miami, FL, USA
                Author notes
                Correspondence: Nancy K Leidy, Evidera, 7101 Wisconsin Avenue, Suite 1400, Bethesda, MD 20814, USA, Tel +1 301 664 7272, Fax +1 301 654 9864, Email nancy.leidy@ 123456evidera.com
                Article
                copd-13-1901
                10.2147/COPD.S152226
                6005334
                © 2018 Leidy et al. This work is published and licensed by Dove Medical Press Limited

                The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.

                Categories
                Original Research

                Respiratory medicine

                peak expiratory flow, undiagnosed copd, case-finding, copd, screening tool

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