Prevalence, Risk Factors and Diagnostic Accuracy of COPD Among Smokers in Primary Care

Abstract

The prevalence of COPD is high, and most cases remain undiagnosed. In contrast, some patients labeled and treated as COPD do not have spirometric confirmation. Our objective was to determine the prevalence of COPD among smokers aged 45 years or older and investigate the accuracy of diagnosis of COPD in primary care. A population-based, epidemiological study was conducted in a primary care centre among subjects older than 45 years with a history of smoking. The participants underwent a clinical questionnaire and spirometry with bronchodilator test. Additionally, participants with newly diagnosed COPD, defined as postbronchodilator FEV1/FVC<0.7, underwent 4-week treatment with formoterol and budesonide to rule out reversible airflow obstruction. A total of 1,738 individuals (84.4% male) with a mean age of 59.9 years were included. The prevalence of COPD was 24.3% (95%, CI 22.3-26.4), with an overall underdiagnosis of 56.7%. Patients with COPD were older, more frequently male, with a lower body mass index, a longer history of smoking, lower educational level, previous occupational exposure, and more cardiovascular co-morbidity (all p < 0.001). After 4 weeks of treatment, 16% of initially obstructed patients had normal spirometry; in addition, 15.6% of individuals with a diagnosis of COPD did not have airflow obstruction. One out of four smokers 45 years or older presenting in primary care have airflow obstruction, mostly undiagnosed. However, among those with an initial diagnosis of COPD up to 16% will normalise spirometry after 4 weeks of treatment. There is also a significant number of individuals misdiagnosed with COPD.

Impact of Chronic Obstructive Pulmonary Disease on Long-Term Outcome in Patients with Coronary Artery Disease Undergoing Percutaneous Coronary Intervention

“…However, COPD remains relatively unknown or ignored by the public as well as public health and government officials [2]. Most of these studies were retrospective and the diagnosis of COPD was based on clinical history only, without spirometric confirmation, which likely led to an evident underdiagnosis, so the prevalence of COPD is often less than that found in the general population [3, 4]. Elevated cardiovascular disease (CVD) risk is observed and significantly increased in patients with COPD [5].…”

Evaluation of clinical variables according to follow-up times in COPD: results from ON-SINT cohort

“…However, in Spain smoking prevalence has been decreasing slightly but with no significant change in the slope over the past decades. [45] Comorbidities are generally expected to increase with time. However, our cohort did not reveal any association between follow-up times and the Charlson Index or other comorbidities including sleep apnea, dyslipidemia, or systemic arterial hypertension.…”

Cardiac Rehabilitation Prevents Recurrent Revascularization in Patients With Coronary Heart Disease

“…Because tobacco smoking is a vital risk factor for chronic obstructive pulmonary disease (COPD), 11 , 12 and approximately 1 in 4 smokers aged 45 years or older presenting in primary care settings has COPD, 13 we used COPD as a proxy for tobacco smoking. Because CHD severity can confound the outcome of interest, factors such as acute or chronic CHD (ICD-9-CM codes 410-411 and 412-414, respectively), length of hospital stay (LOS, a continuous variable), and intensive care unit (ICU) admission (yes or no) were determined and adjusted for in the Cox models.…”