Derivation and Validation of the UCAP-Q Case-finding Questionnaire to Detect Undiagnosed Asthma and COPD
Chau Huynh, G. A. Whitmore, Katherine L. Vandemheen, J. Mark FitzGerald, Celine Bergeron, Louis-Philippe Boulet, Andreanne Cote, Stephen K. Field, Erika Penz, R. Andrew McIvor, Catherine Lemière, Samir Gupta, Irvin Mayers, Mohit Bhutani, Paul Hernandez, M. Diane Lougheed, Christopher J. Licskai, Tanweer Azher, Martha Ainslie, Ian Fraser, Masoud Mahdavian, Gonzalo G. Alvarez, Tetyana Kendzerska, Shawn D. Aaron
European Respiratory Journal 2022; DOI: 10.1183/13993003.03243-2021
Background Many people with asthma and COPD remain undiagnosed. We developed and validated a new case-finding questionnaire to identify symptomatic adults with undiagnosed obstructive lung disease.
Methods Adults in the community with no prior history of physician-diagnosed lung disease who self-reported respiratory symptoms were contacted via random-digit dialing. Pre- and post-bronchodilator spirometry was used to confirm asthma or COPD. Predictive questions were selected using multinomial logistic regression with backward elimination. Questionnaire performance was assessed using sensitivity, predictive values, and area under the receiver operating curve (AUC). The questionnaire was assessed for test-retest reliability, acceptability, and readability. External validation was prospectively conducted in an independent sample and predictive performance re-evaluated.
Results A 13-item UCAP-Q case-finding questionnaire to predict undiagnosed asthma or COPD was developed. The most appropriate risk cut-off was determined to be 6% for either disease. Applied to the derivation sample (N=1615), the questionnaire yielded a sensitivity of 92% for asthma and 97% for COPD, specificity of 17%, with an AUC of 0.69 (95% CI: 0.64–0.74) for asthma and 0.82 (95% CI: 0.78–0.86) for COPD. Prospective validation using an independent sample (n=471) showed sensitivities of 93% and 92% for asthma and COPD, respectively, specificity of 19%, with AUC's of 0.70 (95% CI: 0.62–0.79) for asthma and 0.81 (95% CI: 0.74–0.87) for COPD. AUC's for UCAP-Q were higher compared to AUC's for currently recommended case-finding questionnaires for asthma or COPD.
Conclusions: The UCAP-Q demonstrated high sensitivities and AUC's for identifying undiagnosed asthma or COPD. A web-based calculator allows for easy calculation of risk probabilities for each disease.
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Conflict of Interest Statement for Each Author: Ms. Huynh reports no conflicts of interest, Dr. Whitmore reports no conflicts of interest, Ms. Vandemheen reports no conflicts of interest, Dr. FitzGerald reports no conflicts of interest, Dr. Bergeron reports no conflicts of interest, Dr. Boulet reports receiving grants, consulting fees or honoraria from Amgen, AstraZeneca, GlaxoSmithKline, Merck, Novartis, and Sanofi-Regeneron, Dr. Cote reports receiving honoraria from GlaxoSmithKline, Astra-Zeneca, Sanofi and Covis, Dr. Field reports receiving consulting fees or honoraria from Merck, GlaxoSmithKline, Novartis and Boeringher Ingelheim,
Dr. Penz reports receiving honoraria from Astra-Zeneca, GlaxoSmithKline, Novartis, ICEBM, and Boeringher Ingelheim,
Dr. McIvor reports no conflicts of interest,
Dr. Lemiere reports receiving consulting fees or honoraria from Sanofi, TEVA, GlaxoSmithKline, and Astra-Zeneca,
Dr. Gupta reports no conflicts of interest, Dr. Mayers reports no conflicts of interest,
Dr. Bhutani reports payments or honoraria from AZ, GSK, Novartis, Grifols, Sanofi, Covis, and Valeo,
Dr. Hernandez reports payments or honoraria from AZ, GSK, Novartis, and Valeo, Dr. Lougheed reports receiving grants from AZ and GSK,
Dr. Licskai reports receiving honoraria from Astra-Zeneca, GlaxoSmithKline, Novartis, and Boeringher Ingelheim, Dr. Azher reports no conflicts of interest, Dr. Ainslee reports receiving honoraria from Boeringher Ingelheim, Dr. Fraser reports no conflicts of interest, Dr. Mahdavian reports no conflicts of interest, Dr. Alvarez reports no conflicts of interest, Dr. Kendzerska reports speaker honoraria from Astra-Zeneca.
Dr. Aaron reports sitting on advisory boards and honoraria payments from GlaxoSmithKline, Sanofi, and Astra-Zeneca.
- Received December 24, 2021.
- Accepted March 7, 2022.