TY - JOUR T1 - Performance of alternative COPD case-finding tools: a systematic review and meta-analysis JF - European Respiratory Review JO - EUROPEAN RESPIRATORY REVIEW DO - 10.1183/16000617.0350-2020 VL - 30 IS - 160 SP - 200350 AU - Elena Schnieders AU - Elyesa Ünal AU - Volker Winkler AU - Peter Dambach AU - Valérie R. Louis AU - Olaf Horstick AU - Florian Neuhann AU - Andreas Deckert Y1 - 2021/06/30 UR - http://err.ersjournals.com/content/30/160/200350.abstract N2 - Rationale Guidelines recommend pre-/post-bronchodilator spirometry for diagnosing COPD, but resource constraints limit the availability of spirometry in primary care in low- and middle-income countries. Although spirometry is the diagnostic gold standard, we shall assess alternative tools for settings without spirometry.Methods A systematic literature review and meta-analysis was conducted, utilising Cochrane, CINAHL, Google Scholar, PubMed and Web of Science (search cut-off was May 01, 2020). Published studies comparing the accuracy of diagnostic tools for COPD with post-bronchodilator spirometry were considered. Studies without sensitivity/specificity data, without a separate validation sample and outside of primary care were excluded. Sensitivity, specificity and area under the curve (AUC) were assessed.Results Of 7578 studies, 24 were included (14 635 participants). Hand devices yielded a larger AUC than questionnaires. The meta-analysis included 17 studies and the overall AUC of micro-spirometers (0.84, 95% CI 0.80–0.89) was larger when compared to the COPD population screener (COPD-PS) questionnaire (0.77, 95% CI 0.63–0.85) and the COPD diagnostic questionnaire (CDQ) (0.72, 95% CI 0.64–0.78). However, only the difference between micro-spirometers and the CDQ was significant.Conclusions The CDQ and the COPD-PS questionnaire were approximately equally accurate tools. Questionnaires ensured testing of symptomatic patients, but micro-spirometers were more accurate. A combination could increase accuracy but was not evaluated in the meta-analysis.Micro-spirometry testing in symptomatic patients could enable COPD diagnosis in settings without spirometry. Questionnaires are valuable, as they are easy to implement and test for symptomatic patients. A combination could increase diagnostic accuracy. https://bit.ly/3opHzUA ER -