Performance study of a new diagnostic questionnaire for (Chronic obstructive pulmonary ­disease) COPD with information on exposure to wood smoke, COPD-WS

Performance study of a new diagnostic questionnaire for (Chronic obstructive pulmonary ­disease) COPD with information on exposure to wood smoke, COPD-WS

Authors

  • Alejandra Lozano-Forero Department of Epidemiology, Universidad de La Sabana, Chía, Colombia
  • Eduardo Tuta-Quintero Department of Internal Medicine, Universidad de La Sabana, Chía, Colombia
  • Alirio R. Bastidas Universidad de La Sabana, Chía, Colombia
  • Irma Méndez-Aguirre Department of Internal Medicine, Universidad de La Sabana, Chía, Colombia
  • Miguel A. Molina School of Medicine, Universidad de La Sabana, Chía, Colombia
  • Julian Camacho School of Medicine, Universidad de La Sabana, Chía, Colombia
  • Ivan Guerrero School of Medicine, Universidad de La Sabana, Chía, Colombia
  • Laura Ramirez School of Medicine, Universidad de La Sabana, Chía, Colombia
  • Maria Perez School of Medicine, Universidad de La Sabana, Chía, Colombia
  • Laura Bravo School of Medicine, Universidad de La Sabana, Chía, Colombia
  • Silvia Rojas School of Medicine, Universidad de La Sabana, Chía, Colombia
  • Juan Mejia School of Medicine, Universidad de La Sabana, Chía, Colombia
  • Paula Salazar School of Medicine, Universidad de La Sabana, Chía, Colombia
  • Daniel Maestre School of Medicine, Universidad de La Sabana, Chía, Colombia
  • Juan Moreno School of Medicine, Universidad de La Sabana, Chía, Colombia
  • Laura Cabrera School of Medicine, Universidad de La Sabana, Chía, Colombia
  • Lina Borjas School of Medicine, Universidad de La Sabana, Chía, Colombia
  • Miguel Chacon School of Medicine, Universidad de La Sabana, Chía, Colombia

Keywords:

Copd, Wood smoke, Exposure, Performance

Abstract

Background: To determine the diagnostic performance of a new questionnaire (COPD-WS) that considers also exposure to wood smoke for diagnosing Chronic Obstructive Pulmonary Disease (COPD) in a Colombian population.
Methods: A cross-sectional study was conducted with analysis of diagnostic tests in subjects with and without COPD. Clinical variables were selected based on their relevance to COPD diagnosis, including age, sex, smoking status, exposure to wood smoke, dyspnea, cough, chronic expectoration, and wheezing. A bivariate analysis was performed with the diagnosis of COPD by spirometric criteria. The area under the receiver operating characteristic curve (AUROC) was calculated for the new questionnaire and compared with the LFQ, CDQ, PUMA, COULD IT BE COPD, and COPD-PS questionnaires. The cutoff point for the new questionnaire was obtained through the Youden index, and a p-value <0.05 was considered statistically significant.
Results: A total of 681 patients were included, 187 (27.5%) diagnosed with COPD. The mean age of the population was 65.9 (SD: ±11.79) years, with 53.7% being women and 58.3% having been exposed to wood smoke. The variables included in the questionnaire were age, sex, smoking status, exposure to wood smoke, dyspnea, cough, chronic expectoration, and wheezing. The AUROC for the new COPD-WS questionnaire was 0.69 (95%CI:0.65-0.74;p<0.001), and for a cutoff point ≥6, sensitivity was 0.711 (95%CI:0.677-0.745), specificity was 0.575 (95%CI:0.538-0.612), PPV was 0.388 (95% CI:0.351-0.424), NPV was 0.840 (95%CI:0.813-0.868), LR+ was 1.673 (95%CI:1.458-1.919), LR– was 0.502 (95% CI:0.438-0.576).
Conclusion: This new questionnaire COPD-WS demonstrates acceptable diagnostic capability for diagnosis of COPD in this symptomatic population, and its performance is comparable to other questionnaires currently in use.

References

1. Christenson SA, Smith BM, Bafadhel M, Putcha N. Chronic obstructive pulmonary disease. Lancet 2022; 399(10342):2227-42.

2. Calverley PMA, Walker PP. Contemporary Concise Review 2022: Chronic obstructive pulmonary disease. Respirology 2023;28(5):428-36.

3. López Varela MV, Montes de Oca M, Rey A, Casas A, -Stirbulov R, Di Boscio V. Development of a simple screening tool for opportunistic COPD case finding in primary care in Latin America: The PUMA study. Respirology 2016; 21(7):1227–34.

4. Caballero A, Torres-Duque CA, Jaramillo C, Bolívar F, Sanabria F, Osorio P, et al. Prevalence of COPD in five Colombian cities situated at low, medium, and high altitudes (PREPOCOL study). Chest 2008;133(2):343–9.

5. Bonjour S, Adair-Rohani H, Wolf J, Bruce NG, Mehta S, Prüss-Ustün A, et al. Solid fuel use for household cooking: Country and regional estimates for 1980-2010. Environ Health Perspect 2013;121(7):784–90.

6. Torres-Duque CA, García-Rodriguez MC, -González-García M. Is Chronic Obstructive Pulmonary Disease Caused by Wood Smoke a Different Phenotype or a Different Entity? Arch Bronconeumol 2016;52(8):425-31.

7. Agustí A, Melén E, DeMeo DL, Breyer-Kohansal R, Faner R. Pathogenesis of chronic obstructive pulmonary disease: understanding the contributions of gene--environment interactions across the lifespan. Lancet Respir Med 2022;10(5):512-24.

8. Giraldo-Montoya ÁM, Torres-Duque CA, Giraldo--Cadavid LF, Laucho-Contreras ME, González-Flórez A, Santos AM, et al. Sputum Biomarkers in Wood and Tobacco Smoke Etiotypes of Chronic Obstructive Pulmonary Disease. Int J Chron Obstruct Pulmon Dis 2023;19:1–10.

9. Capistrano SJ, van Reyk D, Chen H, Oliver BG. Evidence of Biomass Smoke Exposure as a Causative Factor for the Development of COPD. Toxics 2017;5(4):36.

10. Po JYT, FitzGerald JM, Carlsten C. Respiratory disease associated with solid biomass fuel exposure in rural women and children: Systematic review and meta-analysis. Thorax 2011;66(3):232–9.

11. Lin CH, Cheng SL, Chen CZ, Chen CH, Lin SH, Wang HC. Current Progress of COPD Early Detection: Key Points and Novel Strategies. Int J Chron Obstruct Pulmon Dis 2023;18:1511-24.

12. Lamprecht B, Soriano JB, Studnicka M, Kaiser B, -Vanfleteren LE, Gnatiuc L, et al. Determinants of underdiagnosis of COPD in national and international surveys. Chest 2015;148(4):971-85.

13. Stanley AJ, Hasan I, Crockett AJ, Van Schayck OCP, Zwar NA. COPD Diagnostic Questionnaire (CDQ) for selecting at-risk patients for spirometry: A cross-sectional study in Australian general practice. NPJ Prim Care Respir Med 2014;10;24.

14. Pagano L, McKeough Z, Wootton S, Zwar N, Dennis S. Accuracy of the COPD diagnostic questionnaire as a screening tool in primary care. BMC Prim Care 2022;23(1):78.

15. Au-Doung PLW, Wong CKM, Chan DCC, Chung JWH, Wong SYS, Leung MKW. PUMA screening tool to detect COPD in high-risk patients in Chinese primary care-A validation study. PLoS One 2022;17(9):e0274106.

16. Guirguis-Blake JM, Senger CA, Webber EM, Mularski R, Whitlock EP. Screening for Chronic Obstructive Pulmonary Disease: A Systematic Evidence Review for the U.S. Preventive Services Task Force. Rockville (MD): Agency for Healthcare Research and Quality (US); 2016 Apr. Report No.: 14-05205-EF-1.

17. 2024 REPORT Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease Global Initiative for Chronic Obstructive Lung Disease Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease. 2023. Available from: www.goldcopd.org

18. Yawn BP, Mapel DW, Mannino DM, Martinez FJ, -Donohue JF, Hanania NA, et al. Development of the Lung Function Questionnaire (LFQ) to identify airflow obstruction. Int J Chron Obstruct Pulmon Dis 2010;5:1-10.

19. Hanania NA, Mannino DM, Yawn BP, Mapel DW, -Martinez FJ, Donohue JF, et al. Predicting risk of airflow obstruction in primary care: Validation of the lung function questionnaire (LFQ). Respir Med 2010;104(8):1160–70.

20. Varela MVL, de Oca MM, Wehrmeister FC, Rodriguez C, Ramirez L, Menezes A. External validation of the PUMA COPD diagnostic questionnaire in a general practice sample and the PLATINO study population. Int J Chron Obstruct Pulmon Dis 2019;14:1901–11.

21. Calverley PM, Nordyke RJ, Halbert RJ, Isonaka S, -Nonikov D. Development of a population-based screening questionnaire for COPD. COPD 2005;2(2):225-32.

22. Martinez FJ, Raczek AE, Seifer FD, Conoscenti CS, Curtice TG, D’Eletto T, et al. Development and initial validation of a self-scored COPD Population Screener Questionnaire (COPD-PS). COPD 2008;5(2):85-95.

23. Hanley JA, McNeil BJ. The meaning and use of the area under a receiver operating characteristic (ROC) curve. Radiology 1982;143(1):29–36.

24. Bastidas AR, Tuta-Quintero E, Arias JS, Cufiño D, Moya D, Martin D, et al. Comparison of the Diagnostic Performance of Five Clinical Questionnaires for Chronic Obstructive Pulmonary Disease. Can Respir J 2023;2023:2821056.

25. Harris PA, Taylor R, Minor BL, Elliott V, Fernandez M, O’Neal L, et al. The REDCap consortium: Building an international community of software platform partners. J Biomed Inform 2019;95:103208.

26. Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)-A metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 2009;42(2):377–81.

27. Dragonieri S, Galloway S, Quaranta VN, Portacci A, Vulpi MR, Santomasi C, et al. Assessment of Five Questionnaires for Chronic Obstructive Pulmonary Disease in a Southern Italian Population: A Proof-of-Concept Study. Medicina (Lithuania) 2023;1;59(7).

28. Sogbetun F, Eschenbacher WL, Welge JA, Panos RJ. A comparison of five surveys that identify individuals at risk for airflow obstruction and chronic obstructive pulmonary disease. Respir Med 2016;1;120:1–9.

29. Ortiz-Quintero B, Martínez-Espinosa I, Pérez-Padilla R. Mechanisms of Lung Damage and Development of COPD Due to Household Biomass-Smoke Exposure: Inflammation, Oxidative Stress, MicroRNAs, and Gene Polymorphisms. Cells 2022;12(1):67.

30. Silva R, Oyarzún M, Olloquequi J. Pathogenic mechanisms in chronic obstructive pulmonary disease due to biomass smoke exposure. Arch Bronconeumol 2015;51(6):285-92.

31. Kaur M, Chandel J, Malik J, Naura AS. Particulate matter in COPD pathogenesis: an overview. Inflamm Res 2022;71(7-8):797-815.

32. González-García M, Maldonado Gomez D, Torres-Duque CA, Barrero M, Jaramillo Villegas C, Pérez JM, Varon H. Tomographic and functional findings in severe COPD: comparison between the wood smoke-related and smoking-related disease. J Bras Pneumol 2013;39(2):147-54.

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Published

01-09-2025

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Section

Original Research Articles

How to Cite

1.
Lozano-Forero A, Tuta-Quintero E, Bastidas AR, et al. Performance study of a new diagnostic questionnaire for (Chronic obstructive pulmonary ­disease) COPD with information on exposure to wood smoke, COPD-WS. Multidiscip Respir Med. 2025;20. doi:10.5826/mrm.2025.1007