The prevalence of airflow obstruction in rural primary care

Dales, Robert; Aaron, Shawn D.; Vandemheen, Katherine L.; Mehdizadeh, Azar; Clinch, Jennifer

doi:10.1016/j.rmed.2005.06.015

Cited by 9 publications

(10 citation statements)

References 12 publications

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“…This prevalence rate among male cigarette smokers is lower than what has been reported in developed countries, including Spain (12.1%),18 Canada (13.1%),19 Sweden (14%),20 and the United States (16%) 21. This can be explained by the fact that our population is generally younger, with more than two thirds of our subjects younger than 60 years.…”

Section: Discussioncontrasting

confidence: 73%

Prevalence of chronic obstructive pulmonary disease among adult male cigarettes smokers: a community-based study in Jordan

Omari¹,

Khassawneh²,

Khader³

et al. 2014

COPD

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Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide. The prevalence of COPD among cigarette smokers in the Middle East is not well studied. A prospective descriptive study was performed in the north of Jordan. Male cigarette smokers (≥10 pack-year) aged 35 years and older were recruited from the community. They completed a questionnaire and a postbronchodilator spirometry. Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria (postbronchodilator forced expiratory volume in 1 second <70%) was used to define COPD. A total of 512 subjects completed the study protocol. According to the GOLD criteria, 42 subjects (8.2%) had COPD. Of those, 27 subjects (64.3%) had symptomatic COPD. Using the GOLD criteria, eight subjects (19%) with COPD had mild disease, 24 (57.1%) had moderate disease, eight (19%) had severe disease, and two (4.8%) had very severe disease. Only 10.6% were aware of COPD as a smoking-related respiratory illness, and 6.4% had received counseling about risk for COPD by a physician. Chronic bronchitis (cough for 3 months in 2 consecutive years) was reported by 15% of the subjects, wheezes by 44.1%, and dyspnea by 65.2%. Subjects with COPD reported having more chronic bronchitis 18/42 (42.9%) and wheezing 28/42 (66.7%) than subjects without COPD. The prevalence of COPD increased with increased number of pack-years smoked. In conclusion, COPD prevalence among cigarette-smoking men in Jordan is lower than in the developed world. COPD was largely underdiagnosed, despite the majority of participants being symptomatic and having moderate to severe disease.

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Section: Discussioncontrasting

confidence: 73%

Prevalence of chronic obstructive pulmonary disease among adult male cigarettes smokers: a community-based study in Jordan

Omari¹,

Khassawneh²,

Khader³

et al. 2014

COPD

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“…We observed a 50% prevalence of unrecognized OLD, higher than that observed in rural, medical inpatient, and Spanish community-based populations 7,9,36. Based on our findings, prevalence estimates of disease burden from OLD are likely to be significantly underestimated in the urban IDU population.…”

Section: Discussionmentioning

confidence: 40%

“…OLD is frequently unrecognized even in smokers 4–6. Several studies have identified populations at higher risk for unrecognized OLD including rural populations,7 the urban homeless,8 and medical inpatients 9,10. Urban populations with a history of current or former drug use represent a poorly studied group with a substantial burden of tobacco abuse and lower socioeconomic status 11–13.…”

Section: Introductionmentioning

confidence: 99%

Prevalence and risk factors for unrecognized obstructive lung disease among urban drug users

Drummond¹,

Kirk²,

Astemborski

et al. 2011

COPD

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BackgroundObstructive lung disease (OLD) is frequently unrecognized and undertreated. Urban drug users are at higher risk for OLD due to race, behavioral, and socioeconomic characteristics, yet little data exist on prevalence and risk factors associated with unrecognized OLD in this population.ObjectiveThe objective of this study is to determine the prevalence of unrecognized OLD in an urban population and identify the characteristics associated with lack of physician-diagnosed OLD.DesignCross-sectional analysis from the Acquired Immunodeficiency Syndrome Linked to the Intravenous Experience (ALIVE) study, an observational study of current and former injection drug users in Baltimore, Maryland, USA.ParticipantsAll participants with spirometry-defined airflow obstruction were stratified by the presence or absence of physician diagnosis of OLD.Main measuresUsing cross-sectional demographic, clinical, and spirometric measurements, multivariable regression models were generated to identify factors independently associated with unrecognized OLD.Key resultsOf the 1083 participants evaluated in the ALIVE lung substudy, 176 (16.3%) met spirometric criteria for OLD. Of those, only 88 (50%) had a physician diagnosis of OLD. The prevalence of unrecognized OLD decreased as severity of airflow obstruction increased. Factors independently associated with unrecognized OLD were absence of respiratory symptoms (prevalence ratio [PR], 1.70; 95% confidence interval [CI]: 1.29–2.23; P < 0.01) and less severe dyspnea (PR, 0.83; 95% CI: 0.72–0.96, per point increase in dyspnea scale; P = 0.01). In the subset of human immunodeficiency virus (HIV)–infected participants, the use of antiretroviral therapy (ART) was independently associated with an increased prevalence of unrecognized OLD (PR, 1.93; 95% CI: 1.05–3.56; P = 0.03).ConclusionsIn a cohort of current and former urban drug users, OLD is substantially underrecognized and associated with lack of respiratory symptoms. Relying on the presence of respiratory symptoms as a trigger to perform spirometry may result in a substantial underdiagnosis of OLD in this population. HIV-infected individuals receiving ART are a population particularly vulnerable to unrecognized OLD.

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“…Accurate knowledge of COPD prevalence in primary care has been considered critical to planning strategies for detection and management of the disease. COPD prevalence in this setting has been analysed elsewhere . Using a similar design to the present study (opportunistic case finding), Hill et al .…”

Section: Discussionmentioning

confidence: 95%

“…Cough was the most common symptom (53.7%). In rural primary care settings, Dales et al . determined COPD prevalence in smokers (≥35 years) presenting for any reason.…”

Section: Discussionmentioning

confidence: 99%

Development of a simple screening tool for opportunistic COPD case finding in primary care in Latin America: The PUMA study

Varela

Gómez-Rey

et al. 2016

Respirology

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Background and objective: Opportunistic chronic obstructive pulmonary disease (COPD) case finding approaches for high-risk individuals with or without symptoms is a feasible option for disease identification. PUMA is an opportunistic case finding study conducted in primary care setting of Argentina, Colombia, Venezuela and Uruguay. The objectives were to measure COPD prevalence in an at-risk population visiting primary care for any reason, to assess the yield of this opportunistic approach and the accuracy of a score developed to detect COPD. Methods: Subjects attending routine primary care visits, ≥40 years of age, current or former smokers or exposed to biomass smoke, completed a questionnaire and performed spirometry. COPD was defined as post-bronchodilator (post-BD) forced expiratory volume in 1 s (FEV 1 )/forced vital capacity (FVC) < 0.70 and the lower limit of normal of FEV 1 /FVC. Results: A total of 1743 subjects completed the interview; 1540 performed acceptable spirometry. COPD prevalence was 20.1% (n = 309; ranging from 11.0% in Venezuela to 29.6% in Argentina) when defined using post-BD FEV 1 /FVC < 0.70, and 14.7% (n = 226; ranging from 8.3% in Venezuela to 21.8% in Colombia) using the lower limit of normal. Logistic regression analysis for both definitions showed that the risk of COPD was significantly higher for persons >50 years, heavy smokers (>30 pack-years), with dyspnoea, and having prior spirometry. A simple score and a weighted score constructed using the following predictive factors: gender, age, pack-years smoking, dyspnoea, sputum, cough and spirometry, had a mean accuracy for detecting COPD (post-BD FEV 1 /FVC < 0.70) of 76% and 79% for the simple and weighted scores, respectively. Conclusion: This simple seven-item score is an accurate screening tool to select subjects for spirometry in primary care.

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The prevalence of airflow obstruction in rural primary care

Cited by 9 publications

References 12 publications

Prevalence of chronic obstructive pulmonary disease among adult male cigarettes smokers: a community-based study in Jordan

Prevalence of chronic obstructive pulmonary disease among adult male cigarettes smokers: a community-based study in Jordan

Prevalence and risk factors for unrecognized obstructive lung disease among urban drug users

Development of a simple screening tool for opportunistic COPD case finding in primary care in Latin America: The PUMA study

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