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Using Tools as Designed [Letter]

Authors Han M, Make B , Yawn BP

Received 26 February 2022

Accepted for publication 12 March 2022

Published 18 March 2022 Volume 2022:17 Pages 591—592


Checked for plagiarism Yes

Editor who approved publication: Dr Richard Russell

MeiLan Han,1 Barry Make,2 Barbara P Yawn3

1Department of Internal Medicine, University of Michigan Health System, Ann Arbor, MI, USA; 2Pulmonary Sciences and Critical Care Medicine, National Jewish Health, Denver, CO, USA; 3Department of Family and Community Health, University of Minnesota, Minneapolis, MN, USA

Correspondence: Barbara P Yawn, Department of Family and Community Health, University of Minnesota, Minneapolis, MN, USA, Tel +1 507 261 3096, Email [email protected]

View the original paper by Miss Zhou and colleagues

A Response to Letter has been published for this article.

Dear editor

We read with interest the article by Zhou et al1 comparing six COPD screening tools in a Chinese population that presented to the Department of Respiratory and Critical Care Medicine of the China Medical University. We applaud this study and its recognition of the importance of assessing COPD screening tools in populations with varying cultural, ethnic, language and health backgrounds. The patients in this study clearly represent a special population of those with sufficient concern to bring them to specialty respiratory care and with high rates of prior and current smoking, low BMIs and average age of >55 years.

As noted by the authors in the description of the questionnaires, CAPTURE is not just five questions.2,3 The CAPTURE tool is five questions and peak flow values for patients with question scores of 2, 3 and 4. As done in the comparative analyses using only the five questions, it is likely that the sensitivity of CAPTURE is overestimated and the specificity is underestimated when peak flows are not included in scoring. It would have been very informative to have CAPTURE “rescored” using the complete tool (questionnaire and peak flow from spirometry that was performed in the study). We recognize that it is possible that in Zhou’s special population both the score and the recommended peak flow values might be different than those recommended in a US primary care population.

The CAPTURE tool was designed to identify people with clinically significant COPD with FEV1/FVC <0.7 and FEV1 <60% predicted or with history of exacerbation like events in prior 12 months—those that would most likely benefit immediately from currently available therapies.3 It would be interesting to assess the performance of the CAPTURE tool in Zhou et al’s population to diagnose the patient group that was the focus for the development of CAPTURE.

We agree with the authors that different screening tools for COPD will have differing sensitivity, specificity and AUC in different populations. In this study’s population, it is not surprising that the LFQ performed particularly well since two of its five questions are based on age, and smoking duration.4 We look forward to a more complete assessment of the full CAPTURE tool in this and other populations.


Dr MeiLan Han reports grants from NIH, grants from COPD Foundation, during the conduct of the study; personal fees for clinical trial with funds paid to institution from AstraZeneca, personal fees and unrestricted funds paid to institution to support a clinical trial from Boehringer Ingelheim, personal fees from GlaxoSmithKline, non-financial support for drug for clinical trial; on a DSMB with fees paid to institution; another clinical trial with funds paid to institution from Novartis, personal fees from Pulmonx, Teva, Verona, Merck, Mylan, clinical trial with funds paid to institution from Sanofi, personal fees from DevPro, Aerogen, Polarian, United Therapeutics, Regeneron, personal fees and stock options from Altesa BioPharma, clinical trial, funds paid to institution from Nuvaira, support for a clinical trial, funds paid to institution from Sunovion, clinical trial, funds paid to institution from Biodesix and Gala Therapeutics, personal fees from Cipla, Chiesi, GSK, stock options from Meissa Vaccines, outside the submitted work. Dr Barry Make reports grants from NHLBI, during the conduct of the study; grants and/personal fees from American Lung Association, Department of Defense, Astra Zeneca, Spiration, Glaxo Smith Kline, Mt. Sinai, Web MD, Novartis, American College of Chest Physicians, Projects in Knowledge, Medscape, Boehringer Ingelheim, Mylan, Third Pole, Eastern Pulmonary Society, Wolters Kluwer Health (Up-To-Date), Optimum Patient Care Global Limited, Integritas Communications, Quintiles, University of Wisconsin, Pearl, and PRIMed, outside the submitted work. Dr Barbara P Yawn reports grants and/or personal fees from NHLBI, PCORI, GlaxoSmithKline, AstraZeneca, Boehringer Ingelheim, TEVA, Medscape, Talem Health, COPD Foundation, and Pulmonx, outside the submitted work. The authors report no other conflicts of interest in this communication.


1. Zhou J, Yu N, Li X, Wang W. Accuracy of six chronic obstructive pulmonary disease screening questionnaires in the Chinese population. Int J Chron Obstruct Pulmon Dis. 2022;17:317–327. doi:10.2147/COPD.S341648

2. Martinez FJ, Mannino D, Leidy NK, et al. A new approach for identifying patients with undiagnosed chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2017;195(6):748–756. doi:10.1164/rccm.201603-0622OC

3. Yawn BP, Han M, Make BM, et al. Protocol summary of the COPD assessment in primary care to identify undiagnosed respiratory disease and exacerbation risk (CAPTURE) validation in primary care study. Chronic Obstr Pulm Dis. 2021;8(1):60–75. doi:10.15326/jcopdf.2020.0155

4. Yawn BP, Mapel DW, Mannino DM, et al. Development of the Lung Function Questionnaire (LFQ) to identify airflow obstruction.. Int J Chron Obstruct Pulmon Dis. 2010;5:1–10.

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