Predictive capability of PUMA score in detection of chronic obstructive pulmonary disease

Abstract

Objective: Chronic obstructive pulmonary disease (COPD) is one of the top three causes of mortality worldwide. The overall incidence rate of COPD was 8.9/1000 person-years. Several studies have evaluated the prevalence of COPD underdiagnosis in different settings. Simple tool to identify COPD cases is extremely useful for physicians. PUMA pre-screening questionnaire is such a tool. The rationale of our study is as our institute is the only institute for 2 districts where pulmonary function test (PFT) is available, so by correlating PUMA score with PFT we could generate questionnaire and use it as as a screening tool in primary care centers where PFT is not available. The aim of the current study was to evaluate predictive capability (sensitivity and specificity) of PUMA score in detecting COPD. Methods: A prospective observational study was conducted from January to March 2024 on 50 patients with clinical suspicion of COPD attending tertiary care center. Seven variables of PUMA questionnaire were used in this study: age (40-49 years-0 points, 50-59 years- 1 point, 60-69 years -2 points), sex (female-0 points, male-1 point), pack years of smoking (30 -3 points), chronic phelgm-1 point, chronic cough-1 point, Dyspnea-1 point and history of previous spirometry -1 points. Details regarding 7 variables and spirometry data were taken and compared. Patient’s consent and ethical committee approval were taken prior to the study. Results: Out of 50 patients, 4 patients were excluded as 3 patients were having pneumothorax and 1 patient had recent eye surgery for which PFT can’t be done. Out of 46 people, 34 (74%) were males and 12 (26%) were females. Most common age group involved was greater than 60 years, which represents 28 (60%) patients. Most common symptom was breathlessness seen in 46 (100%) patients. Past history of spirometry was noted in 9 (19%) patients. 32 (76%) of patients had history of smoking of which >30 pack years of smoking was seen in 21 (46%) of patients. PUMA score greater than or equal to 6 was seen in 32 (69%) of patients in whom obstructive pattern (post bronchodilator FEV1/FVC less than 0.70) in spirometry was seen in 27 (84%) of patients. Conclusion: In primary care centers where spirometry is not available PUMA questionnaire can play a significant role in identifying patients with risk to develop COPD.

Keywords

• puma score
• chronic obstructive pulmonary disease
• spirometry
• smoking pack-years
• accuracy