eprintid: 10206242
rev_number: 10
eprint_status: archive
userid: 699
dir: disk0/10/20/62/42
datestamp: 2025-03-19 09:12:20
lastmod: 2025-03-19 09:13:32
status_changed: 2025-03-19 09:12:20
type: article
metadata_visibility: show
sword_depositor: 699
creators_name: Checkley, William
creators_name: Yang, Mingling
creators_name: Robertson, Nicole M
creators_name: Sharma, Arun K
creators_name: Chandyo, Ram K
creators_name: Shrestha, Laxman
creators_name: Das, Santa K
creators_name: Kirenga, Bruce
creators_name: Alupo, Patricia
creators_name: Gianella, Gonzalo
creators_name: Siddharthan, Trishul
creators_name: Pollard, Suzanne L
creators_name: Quaderi, Shumonta
creators_name: Rykiel, Natalie
creators_name: Flores-Flores, Oscar
creators_name: Hurst, John R
creators_name: Wise, Robert A
creators_name: Global Excellence in COPD outcomes (GECo) study investigators, 
title: Population-based Screening for Chronic Obstructive Pulmonary Disease Using the St. George’s Respiratory Questionnaire in Resource-limited Settings
ispublished: inpress
divisions: UCL
divisions: B02
divisions: C10
divisions: D17
divisions: K71
keywords: COPD; Diagnosis; Low- and Middle-Income Countries
note: This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions.
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 ≥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 < -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 (±SD) total SGRQ score was 7.9±11.9 points, and 20.3±19.4 points in participants with COPD and 6.6±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 ≥12 points and/or pre-bronchodilator PEF <400 L/min for men and <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.
date: 2025-03-11
date_type: published
publisher: American Thoracic Society
official_url: https://doi.org/10.1164/rccm.202409-1862oc
full_text_type: other
language: eng
verified: verified_manual
elements_id: 2371166
doi: 10.1164/rccm.202409-1862OC
medium: Print-Electronic
lyricists_name: Hurst, John
lyricists_id: JHURS15
actors_name: Hurst, John
actors_id: JHURS15
actors_role: owner
full_text_status: restricted
publication: American Journal of Respiratory and Critical Care Medicine
event_location: United States
issn: 1073-449X
citation:        Checkley, William;    Yang, Mingling;    Robertson, Nicole M;    Sharma, Arun K;    Chandyo, Ram K;    Shrestha, Laxman;    Das, Santa K;                                             ... Global Excellence in COPD outcomes (GECo) study investigators; + view all <#>        Checkley, William;  Yang, Mingling;  Robertson, Nicole M;  Sharma, Arun K;  Chandyo, Ram K;  Shrestha, Laxman;  Das, Santa K;  Kirenga, Bruce;  Alupo, Patricia;  Gianella, Gonzalo;  Siddharthan, Trishul;  Pollard, Suzanne L;  Quaderi, Shumonta;  Rykiel, Natalie;  Flores-Flores, Oscar;  Hurst, John R;  Wise, Robert A;  Global Excellence in COPD outcomes (GECo) study investigators;   - view fewer <#>    (2025)    Population-based Screening for Chronic Obstructive Pulmonary Disease Using the St. George’s Respiratory Questionnaire in Resource-limited Settings.                   American Journal of Respiratory and Critical Care Medicine        10.1164/rccm.202409-1862OC <https://doi.org/10.1164/rccm.202409-1862OC>.    (In press).   
 
document_url: https://discovery.ucl.ac.uk/id/eprint/10206242/1/Hurst_SGRQ_1-16-25_track_changes.pdf