@article{discovery10206242,
           month = {March},
           title = {Population-based Screening for Chronic Obstructive Pulmonary Disease Using the St. George's Respiratory Questionnaire in Resource-limited Settings},
            note = {This version is the author accepted manuscript. For information on re-use, please refer to the publisher's terms and conditions.},
       publisher = {American Thoracic Society},
            year = {2025},
         journal = {American Journal of Respiratory and Critical Care Medicine},
          author = {Checkley, William and Yang, Mingling and Robertson, Nicole M and Sharma, Arun K and Chandyo, Ram K and Shrestha, Laxman and Das, Santa K and Kirenga, Bruce and Alupo, Patricia and Gianella, Gonzalo and Siddharthan, Trishul and Pollard, Suzanne L and Quaderi, Shumonta and Rykiel, Natalie and Flores-Flores, Oscar and Hurst, John R and Wise, Robert A and Global Excellence in COPD outcomes (GECo) study investigators, {}},
             url = {https://doi.org/10.1164/rccm.202409-1862oc},
            issn = {1073-449X},
        keywords = {COPD; Diagnosis; Low- and Middle-Income Countries},
        abstract = {Rationale: Spirometry, while necessary for the diagnosis of COPD, remains a scarce and costly resource worldwide. Screening questionnaires may help to bridge the diagnostic gap. Objectives: We evaluated the performance of the St. George's Respiratory Questionnaire (SGRQ) as a screening tool using spirometry-confirmed COPD as a gold standard. Methods: We screened adults aged {$\ge$}40 years for COPD in Bhaktapur, Nepal; Lima, Peru; and Nakaseke, Uganda. Participants completed SGRQs and pre-bronchodilator peak expiratory flow (PEF). We defined COPD as a post-bronchodilator FEV1/FVC Z-score {\ensuremath{<}} -1.645, evaluated the discriminative performance of the SGRQ using receiver operating characteristic curves, and identified the best threshold to screen for spirometry-confirmed COPD. Results: We screened 10709 participants (mean age 56.3 years, 49.7\% males, 15.4\% current smokers). After exclusion for missing data and implausible values, we analyzed data of 10008 participants (94\%). Prevalence of spirometry-confirmed COPD was 9.5\%; mean ({$\pm$}SD) total SGRQ score was 7.9{$\pm$}11.9 points, and 20.3{$\pm$}19.4 points in participants with COPD and 6.6{$\pm$}9.9 points in those without COPD. The area-under-the-curve (AUC) for SGRQ as a screening tool for COPD was 0.77 (95\% CI 0.75-0.79) and the best threshold was 10.75 points. When the SGRQ was combined with pre-bronchodilator PEF stratified by sex, the AUC increased to 0.84 (95\% CI 0.82-0.85). A screening test that combined a total SGRQ score {$\ge$}12 points and/or pre-bronchodilator PEF {\ensuremath{<}}400 L/min for men and {\ensuremath{<}}250 L/min for women yielded a sensitivity of 91\%, a specificity of 47\% and negative predictive value of 98\% to identify spirometry-confirmed COPD. Conclusions: SGRQ is an alternative screening tool for spirometry-confirmed COPD. Screening with the SGRQ in combination with PEF may help to identify people at-risk for COPD in resource-limited settings where spirometry is not readily available.}
}