ArticleBMJ open2021
Accuracy and cost-effectiveness of different screening strategies for identifying undiagnosed COPD among primary care patients (≥40 years) in China: a cross-sectional screening test accuracy study: findings from the Breathe Well group.
Article in BMJ open, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 23 papers, 2 of them syntheses that pooled it.
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Who cites it
23 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Economic evaluations of screening and case-finding for Chronic Obstructive Pulmonary Disease (COPD): a systematic review.NPJ primary care respiratory medicine · 2026Pooled it
- Cost-effectiveness of screening for chronic obstructive pulmonary disease: a systematic review and meta-analysis.BMC public health · 2025Pooled it
- Cost-effectiveness of a self-management maintenance programme following pulmonary rehabilitation: a UK randomised controlled trial for patients with chronic obstructive pulmonary disease.BMJ open respiratory research · 2025Trial
- Impact of the CAPTURE Chronic Obstructive Pulmonary Disease Screening Tool in U.S. Primary Care: A Cluster-Randomized Trial.American journal of respiratory and critical care medicine · 2025Trial
- Short-term effects of air pollutants on asthma hospitalizations in a megacity in North China (2016-2021): a time-series study.Respiratory research · 2026Article
- Predictive performance of the PUMA questionnaire as an opportunistic COPD case-finding tool in Singapore primary care.NPJ primary care respiratory medicine · 2026Observational
- External validation of an IOS-derived model for airflow obstruction and COPD in a community-based cohort.NPJ primary care respiratory medicine · 2026Article
- Construction and Validation of Active Case-Finding Tool in Community Participants with Chronic Obstructive Pulmonary Disease Using an Interpretable Machine Learning Approach.International journal of chronic obstructive pulmonary disease · 2026Article
- A Predicted FEV1/FVC Model Based on a Simple Respiratory Questionnaire for Early Diagnosis of COPD in Shimane Cohort, Japan.International journal of chronic obstructive pulmonary disease · 2026Observational
- Gender Divergence in COPD Phenotypes and Narrowing Urban-Rural Diagnostic Gaps: A Surveillance Study in Chongqing, China, 2020-2024.International journal of chronic obstructive pulmonary disease · 2026Article
- A Two-Staged, Risk-Stratified Strategy Combining FEVRespirology (Carlton, Vic.) · 2025Observational
- Impulse oscillometry-derived equation for prediction of abnormal FEVThe Lancet regional health. Western Pacific · 2025Article
- Screening of COPD patients using the COPD diagnostic questionnaire and a portable spirometer in primary healthcare institutions: a cross-sectional, diagnostic study.BMC pulmonary medicine · 2025Article
- Cost-effectiveness of population-based screening for chronic obstructive pulmonary disease in China: a simulation modeling study.The Lancet regional health. Western Pacific · 2024Article
- Feasibility and performance of the chronic obstructive pulmonary disease population screener and chronic obstructive pulmonary disease screening questionnaire in a Chinese physical examination center.Journal of thoracic disease · 2024Article
- Article
- Engaging stakeholders to level up COPD care in LMICs: lessons learned from the "Breathe Well" programme in Brazil, China, Georgia, and North Macedonia.BMC health services research · 2024Article
- Screening performance of COPD-PS scale, COPD-SQ scale, peak expiratory flow, and their combinations for chronic obstructive pulmonary disease in the primary healthcare in Haicang District, Xiamen City.Frontiers in medicine · 2024Article
- The national COPD screening programme in China: rationale and design.ERJ open research · 2023Article
- Article
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Authors and funding
23 authors.
Funding
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Abstract
objectivesTo examine the accuracy and cost-effectiveness of various chronic obstructive pulmonary disease (COPD) screening tests and combinations within a Chinese primary care population.
designScreening test accuracy study.
settingUrban and rural community health centres in four municipalities of China: Beijing (north), Chengdu (southwest), Guangzhou (south) and Shenyang (northeast).
participantsCommunity residents aged 40 years and above who attended community health centres for any reason were invited to participate. 2445 participants (mean age 59.8 (SD 9.6) years, 39.1% (n=956) male) completed the study (February-December 2019), 68.9% (n=1684) were never-smokers and 3.6% (n=88) had an existing COPD diagnosis. 13.7% (n=333) of participants had spirometry-confirmed airflow obstruction.
interventionsParticipants completed six index tests (screening questionnaires (COPD Diagnostic Questionnaire, COPD Assessment in Primary Care To Identify Undiagnosed Respiratory Disease and Exacerbation Risk (CAPTURE), Chinese Symptom-Based Questionnaire (C-SBQ), COPD-SQ), microspirometry (COPD-6), peak flow (model of peak flow meters used in the study (USPE)) and the reference test (ndd Easy On-PC). PRIMARY AND SECONDARY OUTCOMES: Cases were defined as those with forced expiratory volume in one second (FEV
resultsAirflow measurement devices (sensitivities 64.9% (95% CI 59.5% to 70.0%) and 67.3% (95% CI 61.9% to 72.3%), specificities 89.7% (95% CI 88.4% to 91.0%) and 82.6% (95% CI 80.9% to 84.2%) for microspirometry and peak flow, respectively) generally performed better than questionnaires, the most accurate of which was C-SBQ (sensitivity 63.1% (95% CI 57.6% to 68.3%) specificity 74.2% (95% CI 72.3% to 76.1%)). The combination of C-SBQ and microspirometry used in parallel maximised sensitivity (81.4%) (95% CI 76.8% to 85.4%) and had specificity of 68.0% (95% CI 66.0% to 70.0%), with an incremental cost-effectiveness ratio of £64.20 (CNY385) per additional case detected compared with peak flow.
conclusionsSimple screening tests to identify undiagnosed COPD within the primary care setting in China is possible, and a combination of C-SBQ and microspirometry is the most sensitive and cost-effective. Further work is required to explore optimal cut-points and effectiveness of programme implementation. TRIAL REGISTRATION NUMBER: ISRCTN13357135.
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