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CHWs performing PS were blinded to the LFQ scores and trained researchers were blinded to the LFQ scores and the PS results. Study participants rested for 15–20 minutes between PS and diagnostic spirometry and also between pre and post-BD spirometry. The trained researchers then conducted pre and post-bronchodilation (BD) spirometry using the diagnostic quality spirometers. After ruling out contraindications for spirometry using a checklist, PS was conducted by CHWs.
TWO STAGE SEQUENTIAL TESTING PORTABLE
Height was measured in cm to the nearest 0.1 cm with a portable stadiometer and weight was measured to the nearest 100 gm with a reliable weighing scale in light clothes with no shoes in a standardised manner. 4 Spirometry measures the ratio of forced expiratory volume in one second (FEV 1) to the forced vital capacity (FVC) and the presence of post-bronchodilator FEV 1/FVC18 were invited for assessing their height and weight at nearby community halls of their respective villages. 2, 3 Spirometry is the most reproducible, objective and a non-invasive lung function test. 1 It remains largely undetected due to a lack of awareness among the community and under-diagnosis in clinical practice. Keywords: COPD, sensitivity and specificity, screening, community health workers, spirometryĬhronic Obstructive Pulmonary Disease (COPD) is one of the most common causes of morbidity, disability, and mortality in India. This can potentially contribute to accurate assessment of COPD and thus its effective management in low-resource settings. It could accurately detect 67% of GOLD Stage 1, 78% of GOLD Stage 2, 82% of GOLD Stage 3 and 100% of GOLD Stage 4 individuals with airflow limitation.Ĭonclusion: COPD can be accurately detected by trained CHWs using a simple sequential screening strategy. Results: This strategy of using LFQ followed by pocket spirometry was sensitive (78.6%) and specific (78.8%), with a positive predictive value of 66% and negative predictive value of 88%. Subsequently, trained researchers conducted post-bronchodilator spirometry on these randomly selected individuals using a diagnostic quality spirometer and confirmed the COPD diagnosis according to the Global Initiative for Obstructive Lung Disease (GOLD) criteria (FEV 1/FVC ratio < 0.7). Patients and Methods: Trained CHWs screened all consenting (n=3256) eligible adults in two villages using the Lung Function Questionnaire (LFQ) to assess their COPD risk and conducted pocket spirometry on 268 randomly selected (132 with high risk ie LFQ score ≤ 18 and 136 with low risk ie LFQ score > 18) individuals. The objective of this study was to test the diagnostic accuracy of a sequential two-step screening strategy to detect COPD, implemented by community health workers (CHWs), among adults aged ≥ 40 years in a rural area of North India. Effective strategies for active COPD screening in community settings are needed to increase early identification, risk reduction and timely management. Purpose: Undiagnosed Chronic Obstructive Pulmonary Disease (COPD) results in high morbidity, disability and mortality in India. Public Health Foundation of India, Plot 47, Sector-44, Gurgaon, 122002, India Prashant Jarhyan, 1– 3 Anastasia Hutchinson, 1, 2 Rajesh Khatkar, 1 Dimple Kondal, 1 Mari Botti, 2 Dorairaj Prabhakaran, 1, 3, 4 Sailesh Mohan 1– 3ġCentre for Chronic Conditions and Injuries (CCCI), Public Health Foundation of India, Gurgaon, India 2Institute of Health Transformation, Faculty of Health, Deakin University, Burwood, Melbourne, Australia 3Centre for Chronic Disease Control (CCDC), Delhi, India 4Department of Epidemiology, London School of Hygiene and Tropical Medicine, London, UK