Importance Most of the global morbidity and mortality in chronic obstructive pulmonary disease (COPD) occurs in low- and middle-income countries (LMICs), with significant economic effects. Objective To assess the discriminative accuracy of 3 instruments using questionnaires and peak expiratory flow (PEF) to screen for COPD in 3 LMIC settings. Design, Setting, and Participants A cross-sectional analysis of discriminative accuracy, conducted between January 2018 and March 2020 in semiurban Bhaktapur, Nepal; urban Lima, Peru; and rural Nakaseke, Uganda, using a random age- and sex-stratified sample of the population 40 years or older. Exposures Three screening tools, the COPD Assessment in Primary Care to Identify Undiagnosed Respiratory Disease and Exacerbation Risk (CAPTURE; range, 0-6; high risk indicated by a score of 5 or more or score 2-5 with low PEF [<250 L/min for females and <350 L/min for males]), the COPD in LMICs Assessment questionnaire (COLA-6; range, 0-5; high risk indicated by a score of 4 or more), and the Lung Function Questionnaire (LFQ; range, 0-25; high risk indicated by a score of 18 or less) were assessed against a reference standard diagnosis of COPD using quality-assured postbronchodilator spirometry. CAPTURE and COLA-6 include a measure of PEF. Main Outcomes and Measures The primary outcome was discriminative accuracy of the tools in identifying COPD as measured by area under receiver operating characteristic curves (AUCs) with 95% CIs. Secondary outcomes included sensitivity, specificity, positive predictive value, and negative predictive value. Results Among 10 709 adults who consented to participate in the study (mean age, 56.3 years (SD, 11.7); 50% female), 35% had ever smoked, and 30% were currently exposed to biomass smoke. The unweighted prevalence of COPD at the 3 sites was 18.2% (642/3534 participants) in Nepal, 2.7% (97/3550) in Peru, and 7.4% (264/3580) in Uganda. Among 1000 COPD cases, 49.3% had clinically important disease (Global Initiative for Chronic Obstructive Lung Disease classification B-D), 16.4% had severe or very severe airflow obstruction (forced expiratory volume in 1 second <50% predicted), and 95.3% of cases were previously undiagnosed. The AUC for the screening instruments ranged from 0.717 (95% CI, 0.677-0.774) for LFQ in Peru to 0.791 (95% CI, 0.770-0.809) for COLA-6 in Nepal. The sensitivity ranged from 34.8% (95% CI, 25.3%-45.2%) for COLA-6 in Nepal to 64.2% (95% CI, 60.3%-67.9%) for CAPTURE in Nepal. The mean time to administer the instruments was 7.6 minutes (SD 1.11), and data completeness was 99.5%. Conclusions and Relevance This study demonstrated that screening instruments for COPD were feasible to administer in 3 low- and middle-income settings. Further research is needed to assess instrument performance in other low- and middle-income settings and to determine whether implementation is associated with improved clinical outcomes.

中文翻译：

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慢性阻塞性肺病筛查仪器在 3 个中低收入国家环境中的鉴别准确性。

重要性 慢性阻塞性肺病 (COPD) 的全球发病率和死亡率大部分发生在低收入和中等收入国家 (LMIC)，具有显着的经济影响。目的 评估使用问卷和呼气峰流量 (PEF) 的 3 种仪器在 3 种 LMIC 环境中筛查 COPD 的鉴别准确性。设计、设置和参与者 2018 年 1 月至 2020 年 3 月在尼泊尔半城市巴克塔普尔进行的判别准确性横截面分析；秘鲁利马市区；和乌干达 Nakaseke 农村，使用 40 岁或以上人口的随机年龄和性别分层样本。暴露 三种筛查工具，初级保健中用于识别未确诊呼吸系统疾病和恶化风险的 COPD 评估（CAPTURE；范围，0-6；得分为 5 分或以上或得分 2-5 且 PEF 较低 [女性 <250 L/min，男性 <350 L/min] 的高风险，LMICs 评估问卷中的 COPD（COLA-6；范围， 0-5；得分为 4 分或以上表示为高风险）和肺功能问卷（LFQ；范围为 0-25；得分为 18 分或以下表示为高风险）根据 COPD 的参考标准诊断进行评估使用有质量保证的支气管扩张剂后肺活量测定法。CAPTURE 和 COLA-6 包括 PEF 的测量值。主要结果和测量 主要结果是工具在识别 COPD 时的判别准确度，根据受试者工作特征曲线 (AUC) 下的面积和 95% CI 测量。次要结果包括敏感性、特异性、阳性预测值和阴性预测值。结果 在同意参与研究的 10709 名成年人中（平均年龄 56.3 岁（SD，11.7）；50% 为女性），35% 曾吸烟，30% 目前暴露于生物质烟雾。这 3 个地点的 COPD 未加权患病率在尼泊尔为 18.2%（642/3534 名参与者），在秘鲁为 2.7%（97/3550），在乌干达为 7.4%（264/3580）。在 1000 例 COPD 病例中，49.3% 有临床重要疾病（慢性阻塞性肺病全球倡议分类 BD），16.4% 有严重或非常严重的气流阻塞（1 秒用力呼气量 < 预测值的 50%），95.3% 的病例以前未被确诊。筛查工具的 AUC 范围从秘鲁 LFQ 的 0.717（95% CI，0.677-0.774）到尼泊尔 COLA-6 的 0.791（95% CI，0.770-0.809）。灵敏度范围为 34.8% (95% CI, 25.3%-45. 尼泊尔 COLA-6 的 2% 到尼泊尔 CAPTURE 的 64.2%（95% CI，60.3%-67.9%）。管理仪器的平均时间为 7.6 分钟 (SD 1.11)，数据完整性为 99.5%。结论和相关性 本研究表明，COPD 筛查工具在 3 个中低收入环境中实施是可行的。需要进一步的研究来评估仪器在其他低收入和中等收入环境中的性能，并确定实施是否与改善的临床结果相关。