• Johan Buffels, Jan Degryse, Jan Heyrman, Marc Decramer, and DIDASCO Study.
• Department of General Practice, Katholieke Universiteit, Leuven, Belgium. johan.buffels@coditel.net
• Chest. 2004 Apr 1; 125 (4): 1394-9.

Study ObjectivesTo determine if spirometry is essential for the early detection of COPD in general practice, compared to the screening value of a short questionnaire.MethodsA prospective survey of the population aged 35 to 70 years visiting their general practitioner (GP) during a 12-week period, using a questionnaire on symptoms of obstructive lung disease (OLD). Spirometry was performed in all participants with positive answers and in a 10% random sample from the group without complaints. Twenty GPs were provided with a hand-held spirometer, and received training in performance and interpretation of lung function tests. All 35- to 70-year-old patients (n = 3,408) were screened for current use of bronchodilators. The subgroup receiving bronchodilators (n = 250, 7%) was assumed to have OLD, and was excluded. Airflow obstruction was defined according to the European Respiratory Society standards.ResultsThe positive predictive power of the questionnaire was low (sensitivity, 58%; specificity, 78%; likelihood ratio, 2.6). One hundred twenty-six cases of formerly unknown OLD were detected in the group of patients with complaints, vs an extrapolated number of 90 in the group without complaints. Despite a negative predictive value of 95% for the questionnaire used, 42% of the newly diagnosed cases of OLD would not have been detected without spirometry.ConclusionsThe use of a spirometer is mandatory if early stages of OLD are to be detected in general practice. Screening for airflow obstruction almost doubles the number of known patients with OLD.

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