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

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.