The lower limit of normal <i>versus</i> a fixed ratio to assess airflow limitation: will the debate ever end?

Smith, Lewis J.

doi:10.1183/13993003.00403-2018

Cited by 12 publications

(13 citation statements)

References 12 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The GOLD criteria may underestimate and overestimate disease prevalence in young and older adults, respectively. 30 , 31 Although the lower limit of normal (LLN) measurement has been suggested to aid in COPD diagnosis, LLN-based criteria for diagnosing COPD may lead to COPD underdiagnosis in symptomatic patients. 4 Furthermore, the LLN-based criteria generated more false negatives than did the conventional GOLD criteria; these false negatives led to the undertreatment of patients with COPD during different disease stages (eg, GOLD I and II).…”

Section: Discussionmentioning

confidence: 99%

Performance and Clinical Utility of Various Chronic Obstructive Pulmonary Disease Case-Finding Tools

Chen¹,

Sheu²,

Cheng³

et al. 2021

COPD

View full text Add to dashboard Cite

Background and Aim Chronic obstructive pulmonary disease (COPD) is frequently underdiagnosed because of the unavailability of spirometers, especially in resource-limited outpatient settings. This study provides real-world evidence to identify optimal approaches for COPD case finding in outpatient settings. Methods This retrospective study enrolled individuals who were at risk of COPD (age ≥40 years, ≥10 pack-years, and ≥1 respiratory symptom). Eligible participants were examined using various COPD case-finding tools, namely the COPD Population Screener (COPD-PS) questionnaire, a COPD prediction (P COPD ) model, and a microspirometer, Spirobank Smart; subsequently, the participants underwent confirmatory spirometry. The definition and confirmation of COPD were based on conventional spirometry. Receiver operating characteristic curve (ROC), area under the curve (AUC), and decision curve analyses were conducted, and a clinical impact curve was constructed. Results In total, 385 participants took part in the study [284 without COPD (73.77%) and 101 with COPD (26.23%)]. The microspirometer exhibited a higher AUC value than did the COPD-PS questionnaire and the P COPD model. The AUC for microspirometry was 0.908 (95% confidence interval [CI] = 0.87–0.95), that for the P COPD model was 0.788 (95% CI = 0.74–0.84), and that for the COPD-PS questionnaire was 0.726 (95% CI = 0.67–0.78). Decision and clinical impact curve analyses revealed that a microspirometry-derived FEV1/FVC ratio of <74% had superior clinical utility to the other measurement tools. Conclusion The P COPD model and COPD-PS questionnaire were useful for identifying symptomatic patients likely to have COPD, but microspirometry was more accurate and had higher clinical utility. This study provides real-world evidence to identify optimal practices for COPD case finding; such practices ensure that physicians have convenient access to up-to-date evidence when they encounter a symptomatic patient likely to have COPD.

show abstract

Section: Discussionmentioning

confidence: 99%

Performance and Clinical Utility of Various Chronic Obstructive Pulmonary Disease Case-Finding Tools

Chen¹,

Sheu²,

Cheng³

et al. 2021

COPD

View full text Add to dashboard Cite

show abstract

“…the 5% lower tail of the normal distribution of the average predicted FEV1/FVC ratio in a reference healthy never-smoking population) based on the age range of our study population. We used the Hankinson equation to calculate the predicted values for FEV1/FVC for each participant based on their individual age, sex and height [13][14][15]. Of note, ∼95% of the study participants reported a "White" ethnic origin.…”

Section: Copd Definitionmentioning

confidence: 99%

The occupations at increased risk of COPD: analysis of lifetime job-histories in the population-based UK Biobank Cohort

et al. 2019

View full text Add to dashboard Cite

Occupational exposures are important, preventable causes of chronic obstructive pulmonary disease (COPD). Identification of COPD high-risk jobs is key to focus preventive strategies, but a definitive job-list is unavailable.We addressed this issue by evaluating the association of lifetime job-histories and lung function data in the population-based UK Biobank cohort, whose unprecedented sample size allowed analyses restricted to never-smokers to rule out the most important confounder, tobacco smoking. COPD was spirometrically defined as forced expiratory volume in 1 s/forced vital capacity ratio below the lower limit of normal. Lifetime job-histories were collected via OSCAR (Occupations Self-Coding Automatic Recording), a new validated online tool that automatically codes jobs into the UK Standard Occupational Classification v.2000. Prevalence ratios for COPD by employment duration in each job compared to lifetime office workers were estimated using robust Poisson regression adjusted for age, sex, centre and smoking. Only associations confirmed among never-smokers and never-asthmatics were considered reliable.From the 116 375 participants with complete job-histories, 94 551 had acceptable/repeatable spirometry data and smoking information and were included in the analysis. Six occupations showed an increased COPD risk among never-smokers and never-asthmatics; most of these also with positive exposure-response trends. Interesting new findings included sculptors, gardeners and warehouse workers.COPD patients, especially never-smokers, should be asked about their job-history for better disease management. Focussed preventive strategies in COPD high-risk jobs are warranted.

show abstract

“…The conventional GOLD definition may lead to the underdiagnosis of obstruction in younger adults and overdiagnosis of obstruction in older adults [ 33 , 34 ]. Therefore, scholars have suggested the use of a lower limit of normal (LLN)-based diagnosis of COPD [ 33 , 34 , 35 ]. However, a previous study reported that LLN-based definitions tend to underdiagnose COPD in symptomatic patients [ 4 ].…”

Section: Discussionmentioning

confidence: 99%

Novel App-Based Portable Spirometer for the Early Detection of COPD

et al. 2021

View full text Add to dashboard Cite

Chronic obstructive pulmonary disease (COPD) is preventable and treatable. However, many patients remain undiagnosed and untreated due to the underutilization or unavailability of spirometers. Accordingly, we used Spirobank Smart, an app-based spirometer, for facilitating the early detection of COPD in outpatient clinics. This prospective study recruited individuals who were at risk of COPD (i.e., with age of ≥40 years, ≥10 pack-years of smoking, and at least one respiratory symptoms) but had no previous COPD diagnosis. Eligible participants were examined with Spirobank Smart and then underwent confirmatory spirometry (performed using a diagnostic spirometer), regardless of their Spirobank Smart test results. COPD was defined and confirmed using the postbronchodilator forced expiratory volume in 1 s/forced vital capacity values of <0.70 as measured by confirmatory spirometry. A total of 767 participants were enrolled and examined using Spirobank Smart; 370 participants (94.3% men, mean age of 60.9 years and mean 42.6 pack-years of smoking) underwent confirmatory spirometry. Confirmatory spirometry identified COPD in 103 participants (27.8%). At the optimal cutoff point of 0.74 that was determined using Spirobank Smart for COPD diagnosis, the area under the receiver operating characteristic was 0.903 (95% confidence interval (CI) = 0.860–0.947). Multivariate logistic regression revealed that participants who have an FEV1/FVC ratio of <74% that was determined using Spirobank Smart (odds ratio (OR) = 58.58, 95% CI = 27.29–125.75) and old age (OR = 3.23, 95% CI = 1.04–10.07 for 60 ≤ age < 65; OR = 5.82, 95% CI = 2.22–15.27 for age ≥ 65) had a higher risk of COPD. The Spirobank Smart is a simple and adequate tool for early COPD detection in outpatient clinics. Early diagnosis and appropriate therapy based on GOLD guidelines can positively influence respiratory symptoms and quality of life.

show abstract

The lower limit of normal versus a fixed ratio to assess airflow limitation: will the debate ever end?

Cited by 12 publications

References 12 publications

Performance and Clinical Utility of Various Chronic Obstructive Pulmonary Disease Case-Finding Tools

Performance and Clinical Utility of Various Chronic Obstructive Pulmonary Disease Case-Finding Tools

The occupations at increased risk of COPD: analysis of lifetime job-histories in the population-based UK Biobank Cohort

Novel App-Based Portable Spirometer for the Early Detection of COPD

Contact Info

Product

Resources

About