Risk of over-diagnosis of COPD in asymptomatic elderly never-smokers

Hardie, Jon A.; Buist, A. Sonia; Vollmer, William M.; Ellingsen, Ivar; Bakke, P.; Mørkve, Odd

doi:10.1183/09031936.02.00023202

Cited by 422 publications

(337 citation statements)

References 13 publications

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“…According to a Norwegian study, using the fixed ratio FEV1/FVC to define airway obstruction in elderly subjects may increase the frequency of diagnosing COPD [63]. Applying this knowledge to our study population may, to some extent explain the similar rates of survival in patients without COPD and patients with mild and moderate COPD.…”

Section: Discussion Of Main Resultsmentioning

confidence: 83%

Survival After Surgical Resection for Lung Cancer in Patients With Chronic Obstructive Pulmonary Disease

Bugge

Lund

Brunborg

et al. 2016

The Annals of Thoracic Surgery

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Section: Discussion Of Main Resultsmentioning

confidence: 83%

Survival After Surgical Resection for Lung Cancer in Patients With Chronic Obstructive Pulmonary Disease

Bugge

Lund

Brunborg

et al. 2016

The Annals of Thoracic Surgery

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“…(4) These changes have been designated "senile emphysema" (3,4) and correlate with stage I COPD, which is found in approximately 35% of "healthy" elderly nonsmokers. (5) Because pulmonary emphysema is defined on an anatomical basis, CT is currently the modality of choice for an accurate and noninvasive assessment of in vivo pathological changes. (6) Additionally, HRCT and helical CT can detect and quantify pulmonary emphysema, HRCT and helical CT findings correlating well with histopathological findings.…”

Section: Introductionmentioning

confidence: 99%

Índice de enfisema pulmonar em coorte de pacientes sem doença pulmonar conhecida: influência da idade

et al. 2012

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Objective: To investigate the effects of age on pulmonary emphysema, based on the values of the emphysema index (EI) in a cohort of patients who had never smoked and who had no recognizable lung disease. Methods: We reviewed the CT scans, reported as normal, of 315 patients. Exclusion criteria were a history of smoking, cardiorespiratory disease, and exposure to drugs that could cause lung disease. From this cohort, we selected 32 patients (16 men and 16 women), matched for gender and body mass index, who were divided equally into two groups by age (< 50 years and ≥ 50 years). We quantified emphysema using a computer program specific to that task. The EI was calculated with a threshold of −950 HU. We also evaluated total lung volume (TLV) and mean lung density (MLD). Results: The overall means for TLV, MLD, and EI were 5,027 mL, −827 HU, and 2.54%, respectively. Mean values in the older and younger groups, respectively, were as follows: for TLV, 5,229 mL vs. 4,824 mL (p > 0.05); for MLD, −846 HU vs. −813 HU (p < 0.04); and for EI, 3.30% vs. 1.28% (p < 0.001). Significant correlations were found between EI and age (r = 0.66; p = 0.001), EI and TLV (r = 0.58; p = 0.001), and EI and MLD (r = −0.67; p < 0.001). The predicted EI per age was defined by the regression equation (r 2 = 0.43): p50(EI) = 0.049 × age − 0.5353. Conclusions: It is important to consider the influence of age when quantifying emphysema in patients over 50 years of age. Based on the regression analysis, EI values of 2.6%, 3.5%, and 4.5% can be considered normal for patients 30, 50, and 70 years of age, respectively. Keywords: Pulmonary emphysema; Tomography, spiral computed; Aging; Pulmonary disease, chronic obstructive. ResumoObjetivo: Investigar os efeitos da idade no enfisema pulmonar, com base nos valores do índice de enfisema (IE) em uma coorte de pacientes que nunca fumou e que não possuía doença pulmonar conhecida. Métodos: Foram revisados exames de TC, considerados normais, de 315 pacientes. Tabagismo, doenças cardiorrespiratórias e exposição a drogas que poderiam causar doença pulmonar foram critérios de exclusão. Dessa coorte, selecionamos 32 pacientes (16 homens e 16 mulheres), igualmente divididos em dois grupos (idade < 50 anos e idade ≥ 50 anos), que foram pareados por gênero e índice de massa corpórea. Realizou-se a quantificação do enfisema utilizando um programa específico. O IE foi calculado com um limiar de −950 UH. O volume pulmonar total (VPT) e a densidade pulmonar média (DPM) também foram avaliados. Resultados: As médias gerais de VPT, DPM e IE foram 5.027 mL, −827 UH e 2,54%, respectivamente. A comparação entre os mais velhos e os mais novos mostrou as seguintes médias: VPT (5.229 mL vs. 4.824 mL; p > 0,05); DPM (−846 UH vs. −813 UH; p < 0,04) e IE (3,30% vs. 1,28%; p < 0,001). Houve correlações significativas entre IE e idade (r = 0,66; p = 0,001), IE e VPT (r = 0,58; p = 0,001) e IE e DPM (r = −0,67; p < 0,001). O IE previsto por idade foi definido através da equação de regressão (r 2 = 0,43): p50(IE) = 0,049 × i...

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“…It is well-known that the fixed ratio will overestimate COPD among elderly [38] and the lower limit of normal criteria are nowadays recommended to be used in epidemiological research [39]. Still, most current clinical guidelines for diagnosis and management of COPD are based on the fixed ratio criterion and GOLD stage 2 and above are considered to identify clinically relevant disease [40,41].…”

Section: Discussionmentioning

confidence: 99%

From COPD epidemiology to studies of pathophysiological disease mechanisms: challenges with regard to study design and recruitment process

Lindberg

Linder

Bäckman

et al. 2017

European Clinical Respiratory Journal

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Background: Chronic obstructive pulmonary disease (COPD) is a largely underdiagnosed disease including several phenotypes. In this report, the design of a study intending to evaluate the pathophysiological mechanism in COPD in relation to the specific phenotypes non-rapid and rapid decline in lung function is described together with the recruitment process of the study population derived from a population based study. Method: The OLIN COPD study includes a population-based COPD cohort and referents without COPD identified in 2002–04 (n = 1986), and thereafter followed annually since 2005. Lung function decline was estimated from baseline in 2002–2004 to 2010 (first recruitment phase) or to 2012/2013 (second recruitment phase). Individuals who met the predefined criteria for the following four groups were identified; group A) COPD grade 2–3 with rapid decline in FEV1 and group B) COPD grade 2–3 without rapid decline in FEV1 (≥60 and ≤30 ml/year, respectively), group C) ever-smokers, and group D) non-smokers with normal lung function. Groups A–C included ever-smokers with >10 pack years. The intention was to recruit 15 subjects in each of the groups A-D. Results: From the database groups A–D were identified; group A n = 37, group B n = 29, group C n = 41, and group D n = 55. Fifteen subjects were recruited from groups C and D, while this goal was not reached in the groups A (n = 12) and B (n = 10). The most common reasons for excluding individuals identified as A or B were comorbidities contraindicating bronchoscopy, or inflammatory diseases/immune suppressive medication expected to affect the outcome. Conclusion: The study is expected to generate important results regarding pathophysiological mechanisms associated with rate of decline in lung function among subjects with COPD and the in-detail described recruitment process, including reasons for non-participation, is a strength when interpreting the results in forthcoming studies.

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Risk of over-diagnosis of COPD in asymptomatic elderly never-smokers

Cited by 422 publications

References 13 publications

Survival After Surgical Resection for Lung Cancer in Patients With Chronic Obstructive Pulmonary Disease

Survival After Surgical Resection for Lung Cancer in Patients With Chronic Obstructive Pulmonary Disease

Índice de enfisema pulmonar em coorte de pacientes sem doença pulmonar conhecida: influência da idade

From COPD epidemiology to studies of pathophysiological disease mechanisms: challenges with regard to study design and recruitment process

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