Accuracy of screening tests for chronic obstructive pulmonary disease in primary health care: rapid evidence synthesis

Chronic obstructive pulmonary disease (COPD) is preventable and often remains undetected in its mild and moderate forms. The State Health Resource Centre (SHRC), Chhattisgarh identified a high burden of the condition in the State particularly in areas of high industrial pollution. The Centre requested our RES team to review the existing evidence on effectiveness of different case-finding approaches and the accuracy of screening tests for detecting COPD. The evidence was to be relevant to a primary health care setting and from a low-and-middle income (LMIC) perspective.

The rapid review thus conducted provided the SHRC with a summary of evidence-based policy considerations. This would enable decision makers in improving detection of COPD at the primary health care level in Chhattisgarh.

Key policy considerations:

1. Screening for COPD in primary healthcare should be promoted and appropriate training provided.
2. The COPD Diagnostic Questionnaire (CDQ) might be considered as a screening tool for detecting air flow limitation in general population and facilitate early diagnosis. Those with a high score (>16.5 or 17) should undergo confirmatory test.
3. Use of handheld flow meters under the supervision of trained health professionals in addition to COPD questionnaire is likely to improve accuracy in detection of undiagnosed COPD but leads to additional resource investment
4. Provision for pre and post bronchodilator spirometry as a confirmation test for all the suspected cases of COPD in a Primary Healthcare centre is essential

The full policy brief and technical supplement document are available below:

Download policy brief (PDF 284 KB)

Download supplement document (PDF 463 KB)