Community-Based COPD Screening Using Simplified Spirometry

Abstract Rationale: The low rate of spirometry testing for screening of chronic obstructive pulmonary disease (COPD) is attributed to complex procedures, stringent quality control requirements, and long examination times. Simplifying the spirometry protocol may increase the feasibility of COPD screening in community settings. Objectives: This study aimed to evaluate the diagnostic accuracy and time efficiency of a simplified spirometry protocol compared to routine spirometry in screening for COPD. Methods: We designed a community-based diagnostic study in China. Participants completed a COPD screening questionnaire followed by prebronchodilator and postbronchodilator spirometry tests, using both simplified and routine protocols. Routine spirometry was defined by three maneuvers meeting acceptability and reproducibility criteria according to international standards, while simplified spirometry required only the first acceptable maneuver. The primary outcome was the diagnostic accuracy of prebronchodilator simplified spirometry, measured by the AUC. Secondary outcomes included sensitivity, specificity, and examination time. Results: Out of 632 participants screened, 619 were included in the analysis. The prebronchodilator simplified spirometry demonstrated high diagnostic accuracy (AUC: 0.972 [95%CI: 0.955-0.983]), with sensitivity of 96.6% (95%CI: 94.1-99.1%) and specificity of 86.0% (95%CI: 82.6-89.3%) for identifying spirometric COPD. The average examination time was significantly shorter with prebronchodilator simplified spirometry compared with postbronchodilator routine spirometry (2.8±2.2 minutes vs. 32.1±5.4 minutes; difference: 29.3 minutes [95%CI: 28.9-29.7]). Conclusions: Prebronchodilator simplified spirometry demonstrates high diagnostic accuracy, sensitivity, and specificity for COPD screening in community settings. It significantly reduces examination time compared with routine spirometry, offering a feasible alternative for large-scale COPD screening initiatives.