Back to Journals » International Journal of Chronic Obstructive Pulmonary Disease » Volume 5

Development of the Lung Function Questionnaire (LFQ) to identify airflow obstruction

Authors Yawn BP, Mapel DW, Mannino DM, Martinez FJ, Donohue JF, Hanania NA, Kosinski M, Rendas-Baum R, Mintz M, Samuels S, Dalal A

Published 17 December 2009 Volume 2010:5 Pages 1—10


Review by Single anonymous peer review

Peer reviewer comments 3

Barbara P Yawn1, Douglas W Mapel2, David M Mannino3, Fernando J Martinez4, James F Donohue5, Nicola A Hanania6, Mark Kosinski7, Regina Rendas-Baum7, Matthew Mintz8, Steven Samuels9, Anand A Dalal10, On behalf of the Lung Function Questionnaire Working Group*

1Olmsted Medical Center, Department of Research, Rochester, MN, USA; 2Lovelace Clinic Foundation, Albuquerque, NM, USA; 3University of Kentucky School of Medicine, Lexington, KT, USA; 4University of Michigan Health System, Ann Arbor, MI, USA; 5University of North Carolina School of Medicine, Chapel Hill, NC, USA; 6Baylor College of Medicine, Houston, TX, USA; 7QualityMetric, Inc., Lincoln, RI, USA; 8George Washington University School of Medicine, Washington, DC, USA; 9Indiana Internal Medicine Consultants, Greenwood, IN, USA; 10GlaxosmithKline, Research Triangle Park, NC, USA; *The Lung Function Questionnaire Working Group includes Barbara P Yawn, Douglas W Mapel, David M Mannino, Fernando Martinez, James Donohue, Nicola Hanania, Matthew Mintz, and Steven Samuels

Objective: To describe the item-selection and item-reduction for the Lung Function Questionnaire (LFQ), being developed to help clinicians identify patients appropriate for diagnostic evaluation for chronic obstructive pulmonary disease (COPD) using spirometry.

Methods: Item selection and reduction were based on information from 387 ≥40-year-old respondents to the third National Health and Nutrition Examination Survey who had self-reported chronic bronchitis. Item reduction involved stepwise logistic regression. The accuracy of the final subset of items for identifying individuals with airflow obstruction (forced expiratory volume in one second/forced vital capacity <0.70) versus those without it was assessed with receiver operating characteristic analysis. Content and face validity were assessed using focus groups of primary care physicians (n = 16) and interviews with COPD patients (n = 16).

Results: The model with all five items (age; smoking history; the presence of wheeze, dyspnea, and phlegm) compared with models with combinations of fewer items had the highest classification accuracy (area under the curve [AUC] = 0.720) with sensitivity and specificity of 73.2% and 58.2%, respectively. The presence of three or more factors yielded the highest AUC, a result suggesting that three or more affirmative answers is the most appropriate criterion indicating presence of airflow obstruction.

Conclusions: The five-item LFQ retained sufficient accuracy, sensitivity, and specificity in identifying individuals with COPD for further validation testing.

Keywords: spirometry, chronic obstructive pulmonary disease, respiratory disease, chronic bronchitis, diagnosis, screening

Creative Commons License © 2009 The Author(s). This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at and incorporate the Creative Commons Attribution - Non Commercial (unported, v3.0) License. By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms.