The Peak flow meter with a Questionnaire and Plain Chest Radiography as Diagnostic Tools to detect COPD in Real-life Clinical Practice: A Diagnostic Study
Abstract
Introduction: Correct diagnosis of COPD is important to the treatment. According to the diagnostic criteria for COPD, spirometry test results are required. In Thailand, there are limitations in spirometry because this test cannot be performed in every hospital. However, a peak expiratory flow rate (PEFR) from a peak flow meter is easier and can be performed in every hospital. The objective of this research was to study the effectiveness of peak flow meter with questionnaires and plain chest radiographs as diagnostic tools to detect COPD in real-life clinical practice.
Materials and Methods: The research was a cross sectional analytical study in which all subjects were assessed by questionnaires and were measured PEFR, spirometry, and plain chest radiographs were obtained.
Results: A total of 196 patients were enrolled, 141 patients completed the study. Thirty-nine patients (27.66%) were diagnosed with chronic obstructive pulmonary disease (COPD), 100 (70.93%) with asthma and 2 (1.42%) with bronchiectasis. History of dyspnea (mMRC dyspnea scale ≥1), coughing, or chronic sputum production for at least six months had 100% sensitivity, 3.9% specificity, 28.5% positive predictive value, 100% negative predictive value. PEER <80% predicted had 97.4% sensitivity, 53.9% specificity, 44.7% positive predictive value, 98.2% negative predictive value. Normal plain chest radiographs or with hyperaeration had 69.2% sensitivity, 5.9% specificity, 22.0% positive predictive value, 33.3% negative predictive value in the diagnosis of COPD. Area under the receiver operating characteristic curve (AUC) in the diagnosis of COPD was 96.67% (94.07 – 99.27) when predicted by age, gender, history of dyspnea, coughing, or chronic sputum production for at least 6 months, age of onset ≥40 years, history of smoking, frequent exposure to air pollutions, previous history of pulmonary tuberculosis, PEFR <80% predicted and normal plain chest radiographs or with hyperaeration.
Conclusions: Using data from questionnaires and PEFR <80% predicted and normal plain chest radiographs or with hyperaeration were effective diagnostic tools to detect COPD
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