Characteristics of Subjects With Undiagnosed COPD Based on Post-Bronchodilator Spirometry Data

Hangaard, Stine; Kronborg, Thomas; Hejlesen, Ole

doi:10.4187/respcare.06296

Cited by 8 publications

(11 citation statements)

References 32 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Spirometry is required for a COPD diagnosis (112), but many published observational studies of air pollution exposures and COPD have not used spirometry to define the outcome. It is well recognized that COPD is clinically underdiagnosed (128). Another challenge is inadequate data to adjust for possible confounding from smoking, occupational exposures, or household air pollution from combustion of solid fuels for cooking and heating, and the long latency period for COPD development (52).…”

Section: Workhop Conclusionmentioning

confidence: 99%

Outdoor Air Pollution and New-Onset Airway Disease. An Official American Thoracic Society Workshop Report

Thurston¹,

Balmes²,

Garcia³

et al. 2020

Annals ATS

144

View full text Add to dashboard Cite

Although it is well accepted that air pollution exposure exacerbates preexisting airway disease, it has not been firmly established that long-term pollution exposure increases the risk of new-onset asthma or chronic obstruction pulmonary disease (COPD). This Workshop brought together experts on mechanistic, epidemiological, and clinical aspects of airway disease to review current knowledge regarding whether air pollution is a causal factor in the development of asthma and/or COPD. Speakers presented recent evidence in their respective areas of expertise related to air pollution and new airway disease incidence, followed by interactive discussions. A writing committee summarized their collective findings. The Epidemiology Group found that long-term exposure to air pollution, especially metrics of traffic-related air pollution such as nitrogen dioxide and black carbon, is associated with onset of childhood asthma. However, the evidence for a causal role in adultonset asthma or COPD remains insufficient. The Mechanistic Group concluded that air pollution exposure can cause airway remodeling, which can lead to asthma or COPD, as well as asthma-like phenotypes that worsen with long-term exposure to air pollution, especially fine particulate matter and ozone. The Clinical Group concluded that air pollution is a plausible contributor to the onset of both asthma and COPD. Available evidence indicates that long-term exposure to air pollution is a cause of childhood asthma, but the evidence for a similar determination for adult asthma or COPD remains insufficient. Further research is needed to elucidate the exact biological mechanism underlying incident childhood asthma, and the specific air pollutant that causes it.

show abstract

Section: Workhop Conclusionmentioning

confidence: 99%

Outdoor Air Pollution and New-Onset Airway Disease. An Official American Thoracic Society Workshop Report

Thurston¹,

Balmes²,

Garcia³

et al. 2020

Annals ATS

144

View full text Add to dashboard Cite

show abstract

“…Hundreds of studies involving the diagnosis, epidemiology, or treatment of COPD over the past 15 years have adopted the Global Initiative for Chronic Obstructive Lung Disease (GOLD) spirometric criteria for defining airway obstruction. [19][20][21][22][23] The original rationale for adopting an FEV 1 /FVC of 0.7 was pragmatic in that a simple, easy-to-remember number would promote the use of spirometry to diagnose airway obstruction. Common to all of these studies is the assumption that an FEV 1 /FVC ratio < 0.7 is diagnostic of airway obstruction, despite multiple studies showing that the ratio falls with age and differs with sex and ethnicity.…”

Section: Not All Approaches Are Equalmentioning

confidence: 99%

Pulmonary Function Reference Equations: A Brief History to Explain All the Confusion

et al. 2020

View full text Add to dashboard Cite

Predicted values for pulmonary function tests differ significantly from the reference values used for many other diagnostic tests. Historically, simple equations using age, height, and sex were used to "predict" normal lung function. However, these multiple factors interact in complex ways to determine what the expected lung function values are in healthy subjects. Healthy individuals exhibit a wide range of variability for most pulmonary function variables, and this variability is not consistent across all age ranges. Recent analysis of large groups of healthy subjects has allowed the development of sophisticated prediction models that take into account not only variability but also skew that occurs as the lungs develop and mature. These modern reference equations provide uninterrupted expected values from early childhood, through adolescence and adulthood, and extending into the ninth decade. Modern equations use upper and lower limits of normal to offer a statistically robust means of defining who is within normal limits. Despite these advances, interpretation of pulmonary function test results has not been highly standardized, largely because interpretation depends on the reference equations used and, more importantly, how they are applied. This review discusses the strengths and limitations of using reference equations to interpret pulmonary function data in the context of research and clinical practice.

show abstract

“…Using data obtained from the NHANES survey in the US, Hangaard et al estimated that among 1,098 subjects with post-bronchodilator FEV 1 /FVC < 0.7 or LLN, 92% had no previous diagnosis of COPD, defined by patient self-report (16). The current estimate of diagnosed COPD differs from previous research due to the definition of the study population: whilst the previous research in this area identifies patients prospectively from mid-age or select a group of high-risk individuals whom guidelines recommend should receive a diagnosis, the present study identified COPD diagnosis retrospectively and considered all available medical records to detect physicianidentified disease.…”

Section: Comparison With Existing Literaturementioning

confidence: 99%

Are we missing lifetime COPD diagnosis among people with COPD recorded death? A population-based retrospective cohort study

et al. 2022

View full text Add to dashboard Cite

BackgroundThe British Lung Foundation previously estimated that 2.2 million symptomatic but undiagnosed people with COPD live in the UK.AimThis study investigates the proportion of patients with a missed COPD diagnosis among those with COPD as the cause of death on their death certificate and how this has changed over the past 17 years.Design & settingWe linked Clinical Practice Research Datalink Aurum and GOLD primary care data with Office for National Statistics mortality data and Hospital Episode Statistics data. We included adults who died between 2000 and 2017 with COPD as their main cause of death.MethodUsing a range of diagnostic COPD criteria, we estimated the proportion of patients with a missed COPD diagnosis, and described the demographic and clinical characteristics of patients with and without prior COPD diagnosis using a mixed effect logistic regression model.ResultsDepending on the COPD definition used, between 96% and 27% of the 78,621 patients included received a diagnosis of COPD prior to death. Using presence of a COPD Read or SNOMED CT code and performed spirometry as a main definition, just over half of the patients (52%) had received a COPD diagnosis overall, with a proportion of those who did not decreasing from 91% in 2000 to 31% in 2017 (p-trend <0.001).ConclusionThe proportion of people with COPD-recorded death who had received a diagnosis of COPD has improved over time and currently represents the majority of them, suggesting that few patients are being missed.

show abstract

Characteristics of Subjects With Undiagnosed COPD Based on Post-Bronchodilator Spirometry Data

Abstract: Subjects with undiagnosed COPD were characterized by fewer symptoms and had better lung function than their diagnosed counterparts.

Cited by 8 publications

References 32 publications

Outdoor Air Pollution and New-Onset Airway Disease. An Official American Thoracic Society Workshop Report

Outdoor Air Pollution and New-Onset Airway Disease. An Official American Thoracic Society Workshop Report

Pulmonary Function Reference Equations: A Brief History to Explain All the Confusion

Are we missing lifetime COPD diagnosis among people with COPD recorded death? A population-based retrospective cohort study

Contact Info

Product

Resources

About