Article Text

Study to evaluate the effectiveness and cost-effectiveness of different screening strategies for identifying undiagnosed COPD among residents (≥40 years) in four cities in China: protocol for a multicentre cross-sectional study on behalf of the Breathe Well group
  1. Zihan Pan1,2,
  2. Andrew P Dickens3,
  3. Chunhua Chi1,
  4. Xia Kong1,
  5. Alexandra Enocson3,
  6. Peymane Adab3,
  7. Kar Keung Cheng3,4,
  8. Alice J Sitch3,
  9. Sue Jowett3,
  10. Rachel Jordan3
  11. on behalf of the Breathe Well Group
  1. 1Department of General Practice, Peking University First Hospital, Beijing, China
  2. 2Department of Pulmonary and Critical Care Medicine, Peking University Third Hospital, Beijing, China
  3. 3Institute of Applied Health Research, University of Birmingham, Birmingham, UK
  4. 4General Practice Development and Research Centre, Peking University Health Science Centre, Beijing, China
  1. Correspondence to Professor Chunhua Chi; chichunhua2012{at}; Dr Andrew P Dickens; A.P.Dickens{at}


Introduction The latest chronic obstructive pulmonary disease (COPD) epidemiology survey in China estimated that there were 99 million potential COPD patients in the country, the majority of whom are undiagnosed. Screening for COPD in primary care settings is of vital importance for China, but it is not known which strategy would be the most suitable for adoption in primary care. Studies have been conducted to test the accuracy of questionnaires, expiratory peak flow meters and microspirometers to screen for COPD, but no study has directly evaluated and compared the effectiveness and cost-effectiveness of these methods in the Chinese setting.

Methods and analysis We present the protocol for a multicentre cross-sectional study, to be conducted in eight community hospitals from four cities among Chinese adults aged 40 years or older to investigate the effectiveness and cost-effectiveness of different case-finding methods for COPD, and determine the test performance of individual and combinations of screening tests and strategies in comparison with quality diagnostic spirometry. Index tests are screening questionnaires (COPD Diagnostic Questionnaire (CDQ), COPD Assessment in Primary Care To Identify Undiagnosed Respiratory Disease and Exacerbation Risk Questionnaire (CAPTURE), symptom-based questionnaire, COPD Screening Questionnaire (COPD-SQ)), microspirometer and peak flow. Each participant will complete all of these tests in one assessment. The primary analysis will compare the performance of a screening questionnaire with a handheld device. Secondary analyses will include the comparative performance of each index test, as well as a comparison of strategies where we use a screening questionnaire and a handheld device. Approximately 2000 participants will be recruited over 9 to 12 months.

Ethics and dissemination The study has been approved by Peking University Hospital and University of Birmingham. All study participants will provide written informed consent. Study results will be published in appropriate journal and presented at national and international conferences, as well as relevant social media and various community/stakeholder engagement activities.

Trial registration number ISRCTN13357135.

  • chronic airways disease
  • health economics
  • public health
  • primary care

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  • Collaborators The Breathe Well group

  • Contributors ZP and APD wrote the protocol paper with input from all other authors. RJ led the design of the trial, with contributions and advice from all other investigators. CC, XK, PA and KKC contributed to decisions on outcome measures. CC and KKC advised on involving general practitioner practices, RJ, PA, AE and APD advised on lung function testing. APD and RJ designed the intervention. AJS and SJ designed the analysis plan and economic evaluation. CC was the local principal investigator. All authors have read and approved the final draft.

  • Funding This research was funded by the National Institute for Health Research (NIHR) NIHR global group on global chronic obstructive pulmonary disease in primary care, University of Birmingham, (project reference: 16/137/95) using UK aid from the UK Government to support global health research. The views expressed in this publication are those of the author(s) and not necessarily those of the NIHR or the UK Department of Health and Social Care.

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  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer-reviewed.

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