Polls of busy general internists and family physicians indicate that if this screening questionnaire is more than four questions long, they won’t use it. So, hypothetically, Dr. Martinez said, a three-item questionnaire might consist of something along these lines: How old are you? (Epidemiologic data indicate COPD risk rises at about age 40.) How much do you smoke? (COPD risk begins climbing with a lifetime history of just 100 cigarettes, a mere five packs.) And, do you have symptoms?
Dr. Martinez would like to incorporate in-office peak expiratory flow measurement using a pocket spirometer into the screening tool in light of the findings of a recent study in which he was a principal investigator.
This study of 5,761 patients demonstrated that it’s rare to find severe airflow obstruction in an individual whose FEV1 is at least 60% of the predicted value (Chest 2011 Dec. 22 [Epub ahead of print; PMID 22194590]).
"A peak flow measurement has very good negative predictive value. That could be a useful part of a screening instrument that’s going to need to be very practical," he observed.
Dr. Martinez reported that he serves as a consultant to Actelion, Almirall, AstraZeneca, Bayer, Forest, GlaxoSmithKline, Ikaria, MedImmune, Merck, Novartis, Nycomed, Pearl, and Pfizer.