Discriminative Accuracy of the CAPTURE Tool for Identifying Chronic Obstructive Pulmonary Disease in US Primary Care Settings
Authors: Martinez Fernando J. , Han MeiLan K. , Lopez Camden , Murray Susan , Mannino David , Anderson Stacey , Brown Randall , Dolor Rowena , Elder Nancy , Joo Min , Khan Irfan , Knox Lyndee M. , Meldrum Catherine , Peters Elizabeth , Spino Cathie , Tapp Hazel , Thomashow Byron , Zittleman Linda , Make Barry , Yawn Barbara P. ,   CAPTURE Study Group, White Emily , Scott Cathy , Urbin Megan , Holtzman Jeffrey , Morris Alicia , Smyth Anna , Jhagroo Stefan , LoPiccolo Michelle , Amari Pete , Greig Claudya , Holmes Brandon , Malanga Elisha , Martinez Sergio , McCreary Gretchen , Pasquale Cara , Walsh Linda , Tal-Singer Ruth , Fagerås Malin , Feigler Norbert , Hamblin Angus , Trudo Frank , Tomaszewski Erin , de la Hoz Alberto , Abbott Carl , Sanjar Shahin , Tafur Carlos , Catapano Carole , Gilchrist Kim , Kline Leidy Nancy , Amendola Lindsey , Flores Jose , Ruh Grace , Harvey Tammy , Skipper Ashleigh , Walsh Kate , Warsocki Lauren , Shafayet Abm , Pinargotte Cynthia , Ventuera Melba , Mandania Vikash , Green Donna , Paredas Luis , Barba Erika , Mezzasalma Erica , Williams Lindsey , Westfall Jack , Ancona Jen , Jarell Lori , Kaiser Megan , Sutter Christin , Chatterjee Ranee , Harrell Chad , Harris Taylor , Leathers Kimberly , Mancuso-Mills Beth , Mangum Morgan , Shah Nikita , Leon Bertha , Leon Matthew , Dionicio Patty , Shade Lindsay , Beasley Rebecca , Price Andrea , Oliver Cody , Flynn Christy , Greenberg Stephen , Lowe Lindsay , McAllister Laura , Leonidas Rina , O’Hare Katherine , Strout Kelsey , Thomas Jeremy , Fagnan Lyle J. , Martinez-Armenta Xaviera , Shankle Lindsay , Snow Martha , Vazquez-Trejo Valeria , Tannikula Lisa , Leifer Ariel , Radosta Jonathan , Shim Kyungran , Wells Christina , Garcia Diane , Madrid Samantha , Pacheco Esther , Romo Leonard , Ross Sara , Velazquez Evelyn , Brown Natasha , Bernard Gordon , Barnbaum Deborah , de Andrade Joao , Knoel Daren , Lindenauer Peter , Rogatko Andre , Temprosa Marinella 
Published: February 2023

Importance

Chronic obstructive pulmonary disease (COPD) is underdiagnosed in primary care.

Objective

To evaluate the operating characteristics of the CAPTURE (COPD Assessment in Primary Care To Identify Undiagnosed Respiratory Disease and Exacerbation Risk) screening tool for identifying US primary care patients with undiagnosed, clinically significant COPD.

Design, Setting, and Participants

In this cross-sectional study, 4679 primary care patients aged 45 years to 80 years without a prior COPD diagnosis were enrolled by 7 primary care practice–based research networks across the US between October 12, 2018, and April 1, 2022. The CAPTURE questionnaire responses, peak expiratory flow rate, COPD Assessment Test scores, history of acute respiratory illnesses, demographics, and spirometry results were collected.

Exposure

Undiagnosed COPD.

Main Outcomes and Measures

The primary outcome was the CAPTURE tool’s sensitivity and specificity for identifying patients with undiagnosed, clinically significant COPD. The secondary outcomes included the analyses of varying thresholds for defining a positive screening result for clinically significant COPD. A positive screening result was defined as (1) a CAPTURE questionnaire score of 5 or 6 or (2) a questionnaire score of 2, 3, or 4 together with a peak expiratory flow rate of less than 250 L/min for females or less than 350 L/min for males. Clinically significant COPD was defined as spirometry-defined COPD (postbronchodilator ratio of forced expiratory volume in the first second of expiration [FEV1] to forced vital capacity [FEV1:FVC] &amp;lt;0.70 or prebronchodilator FEV1:FVC &amp;lt;0.65 if postbronchodilator spirometry was not completed) combined with either an FEV1 less than 60% of the predicted value or a self-reported history of an acute respiratory illness within the past 12 months.

Results

Of the 4325 patients who had adequate data for analysis (63.0% were women; the mean age was 61.6 years [SD, 9.1 years]), 44.6% had ever smoked cigarettes, 18.3% reported a prior asthma diagnosis or use of inhaled respiratory medications, 13.2% currently smoked cigarettes, and 10.0% reported at least 1 cardiovascular comorbidity. Among the 110 patients (2.5% of 4325) with undiagnosed, clinically significant COPD, 53 had a positive screening result with a sensitivity of 48.2% (95% CI, 38.6%-57.9%) and a specificity of 88.6% (95% CI, 87.6%-89.6%). The area under the receiver operating curve for varying positive screening thresholds was 0.81 (95% CI, 0.77-0.85).

Conclusions and Relevance

Within this US primary care population, the CAPTURE screening tool had a low sensitivity but a high specificity for identifying clinically significant COPD defined by presence of airflow obstruction that is of moderate severity or accompanied by a history of acute respiratory illness. Further research is needed to optimize performance of the screening tool and to understand whether its use affects clinical outcomes.