Diagnostic Accuracy of a Two-Stage Sequential Screening Strategy Implemented by Community Health Workers (CHWs) to Identify Individuals with COPD in Rural India

Abstract

Prashant Jarhyan,1– 3 Anastasia Hutchinson,1,2 Rajesh Khatkar,1 Dimple Kondal,1 Mari Botti,2 Dorairaj Prabhakaran,1,3,4 Sailesh Mohan1– 3 1Centre 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, UKCorrespondence: Sailesh MohanPublic Health Foundation of India, Plot 47, Sector-44, Gurgaon, 122002, IndiaTel [phone]Fax [phone]Email [email protected]: Undiagnosed Chronic Obstructive Pulmonary Disease (COPD) results in high morbidity, disability and mortality in India. Effective strategies for active COPD screening in community settings are needed to increase early identification, risk reduction and timely management. 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.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. 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 (FEV1/FVC ratio < 0.7).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%. 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.Conclusion: COPD can be accurately detected by trained CHWs using a simple sequential screening strategy. This can potentially contribute to accurate assessment of COPD and thus its effective management in low-resource settings.Keywords: COPD, sensitivity and specificity, screening, community health workers, spirometry

Keywords

• copd
• sensitivity and specificity
• screening
• community health workers
• spirometry