{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,9]],"date-time":"2026-03-09T07:02:47Z","timestamp":1773039767440,"version":"3.50.1"},"reference-count":14,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2025,11,19]],"date-time":"2025-11-19T00:00:00Z","timestamp":1763510400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2025,11,19]],"date-time":"2025-11-19T00:00:00Z","timestamp":1763510400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Respirology"],"published-print":{"date-parts":[[2026,3]]},"abstract":"ABSTRACT<\/jats:title>\n \n Background and Objective<\/jats:title>\n \n The\n COPD<\/jats:styled-content>\n Exacerbation Recognition Tool (\n CERT<\/jats:styled-content>\n ) contains five symptoms that may change at the onset of an exacerbation. It was designed to help patients with\n COPD<\/jats:styled-content>\n recognise the onset of an exacerbation and seek medical attention. This study tested its sensitivity and specificity and further examined its properties.\n <\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n Stable and exacerbating patients presenting to three tertiary hospitals in China were enrolled. Patients' responses to the CERT were compared with physicians' diagnoses made using GOLD 2021 criteria. The CERT was assessed as recommended, and as a total score, using scores assigned to the degree of change for each of the five symptoms (total score 15). Exploratory factor analysis (EFA) was used to identify the key components of the CERT and potentially reduce the number of items.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Sensitivity and specificity of the original CERT were 92.4% and 72.1%. Using a cut\u2010off value of 6, the score\u2010based CERT had the better sensitivity (94.3%) and specificity (86.9%). Concordance between CERT and physician diagnosis was higher with the scored version (kappa 0.833) versus the original version (kappa 0.666). Using EFA, two components were identified \u2018cough and sputum\u2019 and \u2018breathlessness and activity limitation\u2019 with a cumulative variance of 82.3%.<\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n The original and scored\u2010based CERT both had good sensitivity and specificity, but the score\u2010based version showed better concordance with physician diagnosis. The use of two representative items in a 2\u2010item scored version was also effective in identifying acute exacerbations.<\/jats:p>\n <\/jats:sec>\n \n Trial Registration<\/jats:title>\n \n ChiCTR2400090589<\/jats:styled-content>\n registered with\n https:\/\/www.chictr.org.cn<\/jats:ext-link>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1002\/resp.70159","type":"journal-article","created":{"date-parts":[[2025,11,20]],"date-time":"2025-11-20T03:51:44Z","timestamp":1763610704000},"page":"250-255","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Validation and Further Analysis of the\n COPD<\/scp>\n Exacerbation Recognition Tool (\n CERT<\/scp>\n )"],"prefix":"10.1002","volume":"31","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-1789-4352","authenticated-orcid":false,"given":"Xiangju","family":"Xing","sequence":"first","affiliation":[{"name":"Department of Respiratory Medicine The Third Affiliated Hospital of Chongqing Medical University Chongqing China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiang","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine The Third Affiliated Hospital of Chongqing Medical University Chongqing China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paul W.","family":"Jones","sequence":"additional","affiliation":[{"name":"Institute for Infection and Immunity, City St George's University of London London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiuqing","family":"Liao","sequence":"additional","affiliation":[{"name":"Department of Respiratory and Critical Care Medicine Chongqing University Fuling Hospital Chongqing China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Qianli","family":"Ma","sequence":"additional","affiliation":[{"name":"Chronic Respiratory Disease Care and Rehabilitation Center Chongqing Songshan General Hospital Chongqing China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lili","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Respiratory and Critical Care Medicine Chongqing University Fuling Hospital Chongqing China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiaoling","family":"Wei","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine The Third Affiliated Hospital of Chongqing Medical University Chongqing China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chengling","family":"Luo","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine The Third Affiliated Hospital of Chongqing Medical University Chongqing China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yumei","family":"Zhao","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine The Third Affiliated Hospital of Chongqing Medical University Chongqing 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