Tackling the burden of underdiagnosed COPD with PUMA: Screening questionnaire approach in Indonesia’s primary healthcare facilities

Chronic obstructive pulmonary disease (COPD) remains a global challenge. Despite the expanding burden, worldwide study shows that 60%–86% of people with COPD are still not diagnosed. Proyecto Latinoamericano de Investigación en Obstrucción Pulmonar (PUMA) is known as a COPD screening tool in Latin America. This study aims to determine the sensitivity and specificity of the PUMA questionnaire as a COPD screening tool in the Indonesian population. This is a cross-sectional study in several primary care facilities in Jakarta, Indonesia, from July 2019 to January 2020. Participants with PUMA score ≥5 were considered high-risk COPD and proceeded to spirometry examination. COPD diagnoses were based on Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria. A total of 70 high-risk COPD participants were recruited. The receiver operating curve (ROC) curve shows PUMA as a useful diagnostic tool with the area under the curve (AUC) = 0.736 (P = 0.011). The optimal cut-off of PUMA score for COPD diagnosis is 5 with high sensitivity (92%) and enough specificity (60%). There is no difference in PUMA scores among GOLD classifications (P > 0.05). PUMA score with a cut-off value ≥5 can be used as a good screening tool for identifying patients suspected of having COPD.