Implications of using the GLI-2012, GOLD and Australian COPD-X recommendations in assessing the severity of airflow limitation on spirometry among an Indigenous population with COPD: an Indigenous Australians perspective study

Heraganahally, Subash S.; Howarth, Timothy; White, Elisha; Saad, Helmi Ben

doi:10.1136/bmjresp-2021-001135

Cited by 14 publications

(24 citation statements)

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“…Varying manifestations of sex differences in PFTP’s have been demonstrated in this study, both with and without underlying radiological evidence of CADs among an Indigenous Australian cohort. This could also have implications in classifying severity of CADs [ 51 ] and in the clinical decision making while considering airway directed inhaled pharmacotherapy [ 52 ]. We believe the results represented in this study may be an avenue or encourage other researchers in characterising sex differences in other Indigenous populations, with a view to establishing normative reference lung function values for adult Indigenous population.…”

Section: Discussionmentioning

confidence: 99%

Sex differences in pulmonary function parameters among Indigenous Australians with and without chronic airway disease

et al. 2022

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Background Studies assessing normative values and sex differences in pulmonary function test parameters (PFTPs) among Indigenous populations are sparse. Methods PFTPs were compared between male and female Indigenous Australian adults with and without chest radiologically proven chronic airway diseases (CADs). Results 485 adults (56% were female) with no significant difference in age, body mass index or smoking status between sexes were included. Females displayed a higher prevalence of radiology without CADs compared to males (66 vs. 52%, respectively). Among patients without CADs, after adjustment for age, stature and smoking, males displayed significantly higher absolute values of Forced Vital Capacity (FVC) (mean difference, 0.41L (0.21,0.62), p<0.001) and Forced Expiratory Volume in one second (FEV1) (mean difference 0.27L (0.07,0.47), p<0.001), with no significant difference in FEV1/FVC ratio (mean difference -0.02 (-0.06, 0.02), p = 0.174). Male and female patients with radiologically proven CADs demonstrated lower FEV1/FVC values. However, compared to females, males showed significantly greater reductions in pre- [-0.53 (-0.74, -0.32) vs. -0.29 (-0.42, -0.16), p = 0.045] and post- [-0.51 (-0.72, -0.3) vs. -0.27 (-0.39, -0.14), p = 0.049] bronchodilator FEV1. Conclusions There are significant sex differences in the PFTPs among Indigenous Australians. Recognising these differences may be of value in the accurate diagnosis, management, monitoring and prognostication of CADs in this population.

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Section: Discussionmentioning

confidence: 99%

Sex differences in pulmonary function parameters among Indigenous Australians with and without chronic airway disease

et al. 2022

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“…A recent study has highlighted, irrespective of which of the recommended classifications used, COPD-X 46 or GOLD, 1 most Indigenous patients with COPD will likely fall into either the “severe” or “very severe” category. 22 Indigenous patients in this study demonstrated 16–17% lower values for FVC and FEV 1 , compared to non-Indigenous patients. It is inevitable that an Indigenous patient with COPD will likely be assessed to have a higher disease burden by adopting spirometry reference values for the non-Indigenous population.…”

Section: Discussionmentioning

confidence: 49%

“…There has been significant progress in the recent past in addressing respiratory health issues among the adult Indigenous Australian population, especially, from the Top End NT of Australia. 7–11 , 14–17 , 21 , 22 , 47–59 Further studies, however, may be useful to better understand if our study findings are comparable to other Indigenous population both in other parts of Australian and globally, that may change the diagnostic and management of COPD paradigm among Indigenous populations.…”

Section: Discussionmentioning

confidence: 76%

“…In the aforementioned report on spirometry data in Indigenous population, creating a model by arbitrarily inflating FVC and FEV 1 values by 15% (arbitrarily applying a correction factor for Indigenous patients) resulted in a re-categorization of 80% of patients to either “mild” or “moderate” airflow obstruction severity categories - A much closer approximation to the distribution found in non-Indigenous populations. 22 …”

Section: Discussionmentioning

confidence: 99%

“…Also included were datasets from previously published studies of cohorts of participants from the TEHS region NT which included Indigenous and non-Indigenous populations. 15 , 16 , 21 , 22 This study was conducted and reported according to strengthening and reporting of health research involving Indigenous people, including consultation with local institute Indigenous Australian representatives. 23 Individual consent from the study participants was not obtained, as the study was retrospective in nature and no active interventions were investigated in this study.…”

Section: Methodsmentioning

confidence: 99%

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Differences in the Spirometry Parameters Between Indigenous and Non-Indigenous Patients with COPD: A Matched Control Study

Sze¹,

Howarth²,

Lake³

et al. 2022

COPD

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Background Comparison of spirometry parameters between Indigenous and non-Indigenous patients with underlying chronic obstructive pulmonary disease (COPD) has been sparsely reported in the past. In this study, differences in the lung function parameters (LFPs), in particular spirometry values for forced vital capacity (FVC), forced expiratory volume in one second (FEV 1 ) and FEV 1 /FVC ratio between Indigenous and non-Indigenous patients with COPD were assessed. Methods In this retrospective study, Indigenous and non-Indigenous patients with a diagnosis of COPD between 2012–2020 according to spirometry criteria (ie; post-bronchodilator (BD) FEV 1 /FVC < 0.7) were included. A further analysis was undertaken to compare the differences in the spirometry parameters, including lower limit of normal (LLN) values matching for age, sex, height and smoking status between these two diverse ethnic populations. Results A total of 240/742 (32%) Indigenous and 873/4579 (19%) non-Indigenous patients were identified to fit the criteria for COPD. Indigenous patients were significantly younger (mean difference 9.9 years), with a greater proportion of females (50% vs 33%), underweight (20% vs 8%) and current smokers (47% vs 32%). Prior to matching, Indigenous patients’ post-BD percent predicted values for FVC, FEV 1 , and FEV 1 /FVC ratio were 17, 17%, and −2 points lower (Hedges G measure of effect size large (0.91), large (0.87), and small (0.25), respectively). Among the matched cohort (111 Indigenous and non-Indigenous), Indigenous patients LFPs remained significantly lower, with a mean difference of 16%, 16%, and −4, respectively (Hedges G large (0.94), large (0.92) and small (0.41), respectively). The differences persisted despite no significant differences in LLN values for these parameters. Conclusion Indigenous Australian patients with COPD display a significantly different demographic and clinical profile than non-Indigenous patients. LFPs were significantly lower, which may or may not equate to greater severity of disease in the absence of normative predictive lung function reference values specific to this population.

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Significance of lung nodules detected on chest CT among adult Aboriginal Australians – a retrospective descriptive study

Ng,

Howarth,

Doss

et al. 2024

J of Medical Radiation Sci

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IntroductionThere are limited data on chest computed tomography (CT) findings in the assessment of lung nodules among adult Aboriginal Australians. In this retrospective study, we assessed lung nodules among a group of adult Aboriginal Australians in the Northern Territory of Australia.MethodsPatients who underwent at least two chest CT scans between 2012 and 2020 among those referred to undergo lung function testing (spirometry) were included. Chest CT scans were assessed for the number, location, size and morphological characteristics of lung nodules.ResultsOf the 402 chest CTs assessed, 75 patients (18.7%) had lung nodules, and 57 patients were included in the final analysis with at least two CT scans available for assessment over a median follow‐up of 87 weeks. Most patients (68%) were women, with a median age of 58 years and smoking history in 83%. The majority recorded only a single nodule 43 (74%). Six patients (10%) were diagnosed with malignancy, five with primary lung cancer and one with metastatic thyroid cancer. Of the 51 (90%) patients assessed to be benign, 64 nodules were identified, of which 25 (39%) resolved, 38 (59%) remained stable and one (1.8%) enlarged on follow‐up. Nodules among patients with malignancy were typically initially larger and enlarged over time, had spiculated margins and were solid, showing no specific lobar predilection.ConclusionsMost lung nodules in Aboriginal Australians are likely to be benign. However, a proportion could be malignant. Further prospective studies are required for prognostication and monitoring of lung nodules in this population.

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Implications of using the GLI-2012, GOLD and Australian COPD-X recommendations in assessing the severity of airflow limitation on spirometry among an Indigenous population with COPD: an Indigenous Australians perspective study

Cited by 14 publications

References 50 publications

Sex differences in pulmonary function parameters among Indigenous Australians with and without chronic airway disease

Sex differences in pulmonary function parameters among Indigenous Australians with and without chronic airway disease

Differences in the Spirometry Parameters Between Indigenous and Non-Indigenous Patients with COPD: A Matched Control Study

Significance of lung nodules detected on chest CT among adult Aboriginal Australians – a retrospective descriptive study

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