PUMA Questionnaire and Hand-held Spirometry for Early Chronic Obstructive Pulmonary Disease (COPD) Screening

Abstract

Background

Chronic Obstructive Pulmonary Disease (COPD) remains a major cause of global morbidity and mortality, yet it is

often underdiagnosed, particularly in its early stages, as most of the time patients assume these are normal aging

or minor issues like colds, and also due to underutilization of spirometry. Conventional spirometry, though

considered the gold standard, is not always feasible for large-scale screening due to its cost, technical

requirements, and limited availability in primary care settings.

Aim

(1) To assess the utility of the PUMA questionnaire in combination with a handheld COPD-6 spirometer (HSD) for

screening symptomatic smokers.

(2) To evaluate the sensitivity and specificity of these tools individually and in combination, compared with

diagnostic spirometry.

Methods

A cross-sectional study was conducted among current and ex-smokers presenting with respiratory symptoms.

Participants were screened using the PUMA questionnaire and the COPD-6 handheld spirometer. All underwent

confirmatory diagnostic spirometry as the gold standard. Sensitivity, specificity, positive predictive value (PPV),

and negative predictive value (NPV) were calculated for each tool separately and for the combination approach.

Results

The PUMA questionnaire alone showed sensitivity of 83.3% and specificity of 68.4%, while COPD-6 demonstrated

sensitivity of 88.1% and specificity of 75.9%. The combination significantly improved performance, with sensitivity

of 95.2% and specificity of 81.0%. The ROC curve analysis demonstrated an AUC of 0.92 for Combined (PUMA

and COPD-6), indicating excellent diagnostic accuracy. The area under the ROC curve for the combination was

superior to either tool individually, indicating improved diagnostic accuracy.

Conclusion

The combination of the PUMA questionnaire and COPD-6 handheld device provides a practical, cost-effective,

and reliable strategy for early COPD screening in symptomatic smokers. This approach can be particularly

valuable in primary care and community-based settings, where access to full spirometry is limited.