How often is diagnosis of COPD confirmed with spirometry?

Arne, Mats; Lisspers, Karin; Ställberg, Björn; Boman, Gunnar; Hedenström, Hans; Janson, Christer; Emtner, Margareta

doi:10.1016/j.rmed.2009.10.023

Cited by 131 publications

(131 citation statements)

References 36 publications

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“…In the present study, only patient questionnaires were used, and the COPD diagnoses were not confirmed by record review of spirometry, which means that our patient population could potentially include patients with an incorrect COPD diagnosis [21]. However, our purpose was to perform a real-life study of patients with a doctor’s diagnosis of COPD, and spirometry is unfortunately not always performed in clinical praxis.…”

Section: Discussionmentioning

confidence: 99%

“…The 2014 questionnaire was somewhat extended compared with the 2005 questionnaire. The data collection in 2005 also included record reviews and found that spirometry data were not often performed during the study period [21]. As the aim of the present study was to perform a real-life investigation of patients with a doctor’s diagnosis of COPD to reflect the actual pharmacological treatment of COPD according to the GOLD 2017 ABCD groups, we chose to use only questionnaire data here.…”

Section: Methodsmentioning

confidence: 99%

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Factors influencing pharmacological treatment in COPD: a comparison of 2005 and 2014

Sundh

Åberg

Hasselgren

et al. 2017

European Clinical Respiratory Journal

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Introduction: The aim was to investigate how the pattern of pharmacological treatment in Swedish patients with chronic obstructive pulmonary disease (COPD) has changed over a decade, and to identify factors associated with treatment. Methods: Data on patient characteristics and pharmacological treatment were collected using questionnaires from two separate cohorts of randomly selected primary and secondary care patients with a doctor’s diagnosis of COPD in central Sweden, in 2005 (n = 1111) and 2014 (n = 1329). Cross-tabulations and chi-square tests were used to compare maintenance treatment in 2005 and 2014, and to investigate the distribution of treatment by the 2017 Global Initiative for Obstructive Lung Disease (GOLD) ABCD groups. Multinomial logistic regression was used to analyze associations with the major types of recommended treatments: bronchodilator therapy, combined long-acting beta-2-antagonists (LABA) + inhaled corticosteroids (ICS), and triple inhaled therapy. Results: The proportion of patients with no maintenance treatment, with only LABA + ICS, and with sole ICS statistically significantly decreased (36 vs. 31%, 16 vs. 12% and 5 vs. 2%, respectively), and the proportion with triple inhaled therapy statistically significantly increased (29 vs. 40%). In 2014, triple inhaled therapy was the most common treatment in all GOLD groups except group A. In 2014, previous frequent exacerbations [OR (95% CI) 2.34 (1.62 to 3.36)], worse COPD Assessment Test score [1.07 (1.05 to 1.09)], female sex [2.13 (1.56 to 2.91)], and access to a specific responsible doctor [1.95 (1.41 to 2.69)] were associated with triple inhaled therapy. Current smoking [0.40 (0.28 to 0.57)] and overweight [0.62 (0.41 to 0.93)] were inversely associated with triple inhaled therapy. Conclusions: Over the last decade, triple inhaled therapy has increased, and no maintenance treatment, ICS, or LABA + ICS has decreased. Triple inhaled therapy is the most common treatment and is associated with previous exacerbations, higher symptom level, female sex, and having a specific responsible doctor.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Factors influencing pharmacological treatment in COPD: a comparison of 2005 and 2014

Sundh

Åberg

Hasselgren

et al. 2017

European Clinical Respiratory Journal

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“…Spirometry is required for COPD diagnosis [2,4], yet most COPD cases in primary or secondary care are not confirmed by spirometry especially with increasing age [24]. Besides spirometry, COPD diagnosis requires assessment of respiratory symptoms, risk factors and comorbidities [2,4], as even similar degrees of airflow limitation have different effects on symptoms, comorbidities and outcomes [25,26].…”

Section: Discussionmentioning

confidence: 99%

Airflow limitation by the Global Lungs Initiative equations in a cohort of very old adults

et al. 2015

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The cut-off for forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC) defining airflow limitation for chronic obstructive pulmonary disease (COPD) is still contested. We assessed airflow limitation prevalence by the lower limit of normal (LLN) of Global Lungs Initiative (GLI) 2012 reference values and its predictive ability for all-cause mortality and hospitalisation in very old adults (aged ⩾80 years) compared with the fixed cut-off.In a Belgian population-based prospective cohort of 411 very old adults, airflow limitation prevalence by the 5th percentile of GLI 2012 z-scores (GLI-LLN) and fixed cut-off (0.70) were compared with COPD reported by general practitioners (GPs). Survival and Cox regression multivariable analysis assessed the association of airflow limitation by both cut-offs with 5-year all-cause mortality and first hospitalisation at 3 years.9.2% had airflow limitation by GLI-LLN and 27% by fixed cut-off, without good agreement (kappa coefficient ⩽0.40) with GP-reported COPD (9%). Only airflow limitation by GLI-LLN was independently associated with mortality (adjusted hazard ratio 2.10, 95% CI 1.30-3.38). FEV1/FVC <0.70 but ⩾GLI-LLN (17.8%) had no significantly higher risk for mortality or hospitalisation.In a cohort of very old adults, airflow limitation by GLI-LLN has lower prevalence than by fixed cut-off, independently predicts all-cause mortality and does not miss individuals with significantly higher all-cause mortality and hospitalisation. Support statement: The BELFRAIL study (B40320084685) was supported by an unconditional grant from Fondation Louvain, Brussels, Belgium. Fondation Louvain is the support unit of Université Catholique de Louvain and is charged with developing the educational and research projects of the university by collecting gifts from corporations, foundations and alumni. Funding information for this article has been deposited with FundRef.

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“…Individuals with nonobstructed spirometric abnormalities have not been fully characterized by imaging, and it remains unclear how these individuals are radiologically different from smokers with normal FEV1 values. 4,6,8,9 Therefore, the purpose of our study was to identify the differences in CT findings between this GOLDU group of individuals and a control group of smokers with normal lung function.…”

Section: Introductionmentioning

confidence: 99%

Visual Assessment of CT Findings in Smokers With Nonobstructed Spirometric Abnormalities in the COPDGene® Study

et al. 2014

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Within the COPD Genetic Epidemiology (COPDGene®) study population of cigarette smokers, 9% were found to be unclassifiable by the Global Initiative for chronic Obstructive Lung Disease (GOLD) criteria. This study was to identify the differences in computed tomography (CT) findings between this nonobstructed (GOLDU) group and a control group of smokers with normal lung function. This research was approved by the institutional review board of each institution. CT images of 400 participants in the COPDGene® study (200 GOLDU, 200 smokers with normal lung function) were retrospectively evaluated in a blinded fashion. Visual CT assessment included lobar analysis of emphysema (type, extent), presence of paraseptal emphysema, airway wall thickening, expiratory air trapping, centrilobular nodules, atelectasis, non-fibrotic and fibrotic interstitial lung disease (ILD), pleural thickening, diaphragmatic eventration, vertebral body changes and internal thoracic diameters (in mm). Univariate comparisons of groups for each CT parameter and multiple logistic regression were performed to determine the imaging features associated with GOLDU. When compared with the control group, GOLDU participants had a significantly higher prevalence of unilateral diaphragm eventration (30% vs. 16%), airway wall thickening, centrilobular nodules, reticular abnormality, paraseptal emphysema (33% vs. 17%), linear atelectasis (60% vs. 35.6%), kyphosis (12% vs. 4%), and a smaller internal transverse thoracic diameter (255 ± 22.5 [standard deviation] vs. 264.8 ± 22.4, mm) (all p<0.05). With multiple logistic regression, all of these CT parameters, except non-fibrotic ILD and kyphosis, remained significantly associated with GOLDU status (p<0.05). In cigarette smokers, chest wall abnormalities and parenchymal lung disease, which contribute to restrictive physiologic impairment, are associated with GOLD-nonobstructed status.

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How often is diagnosis of COPD confirmed with spirometry?

Abstract: Only a third of Swedish patients with COPD had their diagnosis confirmed with spirometry. Our data indicate that female gender, current smoking, higher BMI and short exhalation time increase the risk of being diagnosed with COPD without fulfilling the spirometric criteria for the disease.

Cited by 131 publications

References 36 publications

Factors influencing pharmacological treatment in COPD: a comparison of 2005 and 2014

Factors influencing pharmacological treatment in COPD: a comparison of 2005 and 2014

Airflow limitation by the Global Lungs Initiative equations in a cohort of very old adults

Visual Assessment of CT Findings in Smokers With Nonobstructed Spirometric Abnormalities in the COPDGene® Study

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