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
(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
, 211
(5)
pp. 779-788.
10.1164/rccm.202409-1862OC.
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Abstract
Rationale: Spirometry, although necessary for the diagnosis of chronic obstructive pulmonary disease (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 and older for COPD in Bhaktapur, Nepal; Lima, Peru; and Nakaseke, Uganda. Participants completed SGRQs and prebronchodilator peak expiratory flow (PEF). We defined COPD as a postbronchodilator FEV1/FVC Z-score less than −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. // Measurements and Main Results: We screened 10,709 participants (mean age, 56.3 yr; 49.7% male; 15.4% current smokers). After exclusion for missing data and implausible values, we analyzed the data of 10,008 (94%) participants. Prevalence of spirometry-confirmed COPD was 9.5%; mean SGRQ scores were 7.9 points (SD = 11.9) for the total population, 20.3 points (SD = 19.4) for participants with COPD, and 6.6 points (SD = 9.9) for participants without COPD. The area under the curve for SGRQ as a screening tool for COPD was 0.77 (95% confidence interval, 0.75–0.79), and the best threshold was 10.75 points. When the SGRQ was combined with prebronchodilator PEF stratified by sex, the area under the curve increased to 0.84 (95% confidence interval, 0.82–0.85). A screening test that combined a total SGRQ score of 12 points and higher and/or prebronchodilator 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.
| Type: | Article |
|---|---|
| Title: | Population-Based Screening for Chronic Obstructive Pulmonary Disease Using the St. George’s Respiratory Questionnaire in Resource-Limited Settings |
| Location: | United States |
| Open access status: | An open access version is available from UCL Discovery |
| DOI: | 10.1164/rccm.202409-1862OC |
| Publisher version: | https://doi.org/10.1164/rccm.202409-1862oc |
| Language: | English |
| Additional information: | This article is open access and distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives License 4.0, https://creativecommons.org/licenses/by-nc-nd/4.0/. |
| Keywords: | COPD; Diagnosis; Low- and Middle-Income Countries |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Medicine UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Medicine > Respiratory Medicine |
| URI: | https://discovery.ucl.ac.uk/id/eprint/10206242 |
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