Underdiagnosis of obstructive lung disease: findings from the French CONSTANCES cohort

Abstract

Background The burden of undiagnosed obstructive lung disease (OLD) (mainly asthma and chronic obstructive pulmonary disease) is not fully established, and targets for corrective action are yet to be identified. We assessed the underdiagnosis of OLD and its determinants in France. Methods CONSTANCES is a French population-based cohort of adults aged 18–69 years at inception. We analysed data collected at inclusion in 2013–2014. Undiagnosed OLD was defined as spirometry-confirmed airflow limitation (FEV1/FVC < lower limit of normal) without prior diagnosis of asthma, chronic obstructive pulmonary disease, or bronchiectasis. Multivariate analysis was performed with weighted robust Poisson regression models to estimate the adjusted prevalence ratios (aPR) of undiagnosed OLD. Results Spirometry results were available for 19,398 participants. The prevalence of airflow limitation was 4.6%. Overall, 64.4% of adults with airflow limitation did not report a previous diagnosis of OLD. Individuals with high cumulative tobacco consumption (≥ 10 pack-years) (aPR: 1.72 [1.28–2.32]), without respiratory symptoms (aPR: 1.51 [1.28–1.78]), and with preserved lung function (aPR: 1.21 [1.04–1.41] for a 10-point increase in FEV1% predicted) had a higher risk of being undiagnosed. Half of symptomatic individuals with airflow limitation (45% of those with moderate to severe airflow limitation) were undiagnosed with OLD. Conclusion Underdiagnosis of OLD is very common among French adults, even in patients with respiratory symptoms. Efforts should be made in France to raise awareness about OLD in the general population, improve the detection of respiratory symptoms, and increase the use of spirometry among primary care professionals.

Diagnosing asthma and chronic obstructive pulmonary disease

“…However, when patients present with respiratory symptoms suggestive of airways disease, it is important to consider the possibility of asthma or COPD (referred to as case finding), as these conditions are also often missed. 16 Typical asthma symptoms include wheeze, shortness of breath, and chest tightness. Specific clues include worsening of these symptoms at night or early in the morning, the variable and episodic nature of symptoms, and triggers for symptoms (eg, viral infections, exercise, allergens, and irritants such as strong smells or cold air).…”

Long-term exposure to ambient air pollution and asthma symptom score in the CONSTANCES cohort

“…Indeed, in an international study in 70 countries, one-third of French participants aged 18–45 years with asthma symptoms (attacks of wheezing or whistling breath in the past 12 months) were not diagnosed with asthma 25. In addition, in a recent paper by Delmas et al 26, with data from the CONSTANCES cohort, 64.4% of participants with airflow limitation did not report a previous diagnosis of obstructive lung disease (asthma, COPD or bronchiectasis). This score has the advantage of characterising and quantifying asthma symptoms in participants who have never been labelled as asthmatics.…”

Asthma and its relationship with anthropometric markers among adults

“…Third, the potential bias of self-reporting asthma may have led to misclassification of asthma that should be another obstructive respiratory disease, such as COPD [33]. Numerous studies have indicated that asthma-COPD phenotype overlap syndrome frequently leads to undiagnosed asthma [34,35].…”