• Shamil Haroon, Rachel Jordan, Yemisi Takwoingi, and Peymane Adab.
• Public Health, Epidemiology & Biostatistics, School of Health and Population Sciences, University of Birmingham, Birmingham, UK.
• BMJ Open. 2015 Oct 8; 5 (10): e008133.

BackgroundChronic obstructive pulmonary disease (COPD) is widely underdiagnosed. A number of studies have evaluated the accuracy of screening tests for COPD, but their findings have not been formally summarised. We therefore sought to determine and compare the diagnostic accuracy of such screening tests in primary care.MethodsSystematic review and meta-analysis of the diagnostic accuracy of screening tests for COPD confirmed by spirometry in primary care. We searched MEDLINE, EMBASE and other bibliographic databases from 1997 to 2013 for diagnostic accuracy studies that evaluated 1 or more index tests in primary care among individuals aged ≥35 years with no prior diagnosis of COPD. Bivariate meta-analysis of sensitivity and specificity was performed where appropriate. Methodological quality was assessed independently by 2 reviewers using the QUADAS-2 tool.Results10 studies were included. 8 assessed screening questionnaires (the COPD Diagnostic Questionnaire (CDQ) was the most evaluated, n=4), 4 assessed handheld flow meters (eg, COPD-6) and 1 assessed their combination. Among ever smokers, the CDQ (score threshold ≥19.5; n=4) had a pooled sensitivity of 64.5% (95% CI 59.9% to 68.8%) and specificity of 65.2% (52.9% to 75.8%), and handheld flow meters (n=3) had a sensitivity of 79.9% (95% CI 74.2% to 84.7%) and specificity of 84.4% (68.9% to 93.0%). Inadequate blinding between index tests and spirometry was the main risk of bias.ConclusionsHandheld flow meters demonstrated higher test accuracy than the CDQ for COPD screening in primary care. The choice of alternative screening tests within whole screening programmes should now be fully evaluated.Prospero Registration NumberCRD42012002074.Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

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