الفهرس | Only 14 pages are availabe for public view |
Abstract The present study was conducted in The National Center of Chest Diseases of Imbaba. Two groups were chosen: the first group included fifty known COPD patients, diagnosed according to GOLD 2014, on their medications and the second group was fifty apparently healthy smokers. Subjects were all males from EL-Giza governorate in the period between January 2014 and July 2014. The aim of this study was to validate the use of the five items of modified Lung Function Questionnaire to detect those appropriate for spirometry testing for airflow obstruction. Exclusion criteria: history of atopy, younger than forty, patients with acute respiratory illness, patients with known (non-respiratory) disease causing dyspnea and history of concomitant lung diseases like sarcoidosis. All subjects were submitted to: Full medical history taking. Thorough clinical examination. The weight in Kg, the height in Cm and BMI. Radiological examinations: Plain postero-anterior chest X-ray was done to exclude any chest lesion if present. Participants answered the questions covering demographics and symptoms by Arabic translation of modified Lung Function Questionnaire which is five questions with scoring system from five to twenty five according to research developed by Yawn and colleagues in 2010. Simple spirometry, prebronchodilator and postbronchodilator, according to GOLD guidelines 2014. Pulmonary function tests were performed using smart pft USB, medical equipment Europe Dr.-Georg- Schaefer-Str. 1497762 Hammelburg, Germany. Results were tabulated and statistically analyzed: The prevalence of COPD in the studied sample (50 smokers) was 30% slightly higher than known numbers and it cannot be generalized because the sample was small and may be biased by convenient sampling. There was significant difference between the fifteen newly diagnosed COPD cases and the thirty five healthy smokers as regard: weight, BMI, prebronchodilator FEV1/FVC, MEF25-75 and MMRC dyspnea scale. Also comparison between them considering how they answered the modified LFQ, there was statistically significant difference as regard the first, second and third questions. Logistic regression of the five items of the modified LFQ found that the third question (shortness of breath) was the only item which significantly predict airway obstruction (p-value = 0.04). Also the total score significantly predicted airway obstruction (p-value = 0.01). The ROC curve for the modified LFQ found that at cut point 13 (LFQ score = 13) the sample had sensitivity 73.5%, specificity 73.3%, positive predictive value 86.2% and negative predictive value 55% with fairly high area under the ROC curve 0.79%. The ROC curve for every question of the modified LFQ alone showed that the first and third questions (cough and dyspnea respectively) alone already related significantly with the diagnoses of COPD with AUC of 0.77% and 0.75% respectively. Lower cut-point levels were associated with greater detection of patients with airflow obstruction (higher sensitivity) but also included some subjects not having airflow obstruction (low specificity). The opposite was true at higher scores. Thus, selection of a particular cut-point value can be adapted for a particular application. Conclusion: Using modified Lung Function Questionnaire can aid as a first-line screening tool to identify patients with airflow obstruction for further investigations using spirometry to identify patients with COPD. |