Determinants of Underdiagnosis of COPD in National and International Surveys

Lamprecht, Bernd; Soriano, Joan B.; Studnicka, Michael; Kaiser, Bernhard; Vanfleteren, Lowie E.G.W.; Gnatiuc, Louisa; Burney, Peter; Miravitlles, Marc; García‐Río, Francisco; Akbari, Kaveh; Ancochea, Julio; Menezes, Ana Maria Baptista; Pérez‐Padilla, Rogelio; de, María Montes; Torres-Duque, Carlos A.; Caballero, Andrés; González-García, Mauricio; Buist, Sonia

doi:10.1378/chest.14-2535

Cited by 347 publications

(288 citation statements)

References 34 publications

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“…The authors' success in conducting a standardized BOLD study protocol highlights the positive and continued influence of the BOLD initiative in guiding comparable and population-based research data in sSA (14,16). The findings of this research reinforce the need for future longitudinal studies that can validate spirometry Mean age (years) Prevalence (%) Figure 1.…”

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confidence: 66%

“…As the "correct" reference population remains debatable, it may be informative to also compare the Malawian population with the African-American participants in NHANES III (15). Given the human and financial costs of misdiagnosis, development of a case definition of obstructive and restrictive lung disease that is adaptable to diverse global populations is a public health priority (6,16,17).…”

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confidence: 99%

“…metrics in diverse populations, provide greater clarity about modifiable exposures for NCLD, and explore the long-term health outcomes of NCLD in resource-poor settings (18). As we await data from these future studies, consortiums such as the BOLD initiative will continue to improve local health infrastructures and medical provider knowledge and remain critical to advancing our knowledge of the global burden of NCLD (7,8,14,16,19). n…”

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confidence: 99%

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Barriers to Understanding the Epidemiology of Noncommunicable Lung Disease in Sub-Saharan Africa

Harhay

Rudan

2016

Am J Respir Crit Care Med

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confidence: 66%

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confidence: 99%

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Barriers to Understanding the Epidemiology of Noncommunicable Lung Disease in Sub-Saharan Africa

Harhay

Rudan

2016

Am J Respir Crit Care Med

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“…The recent Global Burden of Disease update estimated the number of people worldwide with COPD to be 328 million [4]. However, given the likely ecological fallacy [5], for a universally very high level of underdiagnosis [6], there are many questions that remain unanswered relating to the elderly with COPD. A research call for COPD in the elderly, similar to that for asthma in the elderly, is needed [7].…”

Section: @Erspublicationsmentioning

confidence: 99%

Ageing lungs and very elderly COPD: anytime and anywhere

Soriano

Suissa

2016

Eur Respir J

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@ERSpublicationsWithin the current epidemiological transition, expect and find incident COPD cases anytime, anywhere http://ow.ly/UOccWThe recent European Respiratory Society/American Thoracic Society Task Force for COPD Research statement [1] requested new studies that "…evaluate the impact of age on the importance of identifying an airflow limitation (i.e. is it more important to identify asymptomatic airflow limitation in a 30-year-old than an 80-year-old?)", as well as those studies that compare outcomes among individuals diagnosed with chronic obstructive pulmonary disease (COPD) on the basis of the fixed ratio versus lower limit of normal (LLN) thresholds. In this issue of the European Respiratory Journal (ERJ), LUOTO et al. [2] report the results of a study that fulfils both goals.The world's population is ageing at a prodigious rate and it is anticipated the life span of newborns in the year 2000 in many Western countries might reach 100 years [3]. Ergo, the frequency of noncommunicable diseases will increase exponentially, and COPD, intrinsically associated with ageing and tobacco use/ exposure, is also expected to increase its burden, as many more people will live with it for longer. The recent Global Burden of Disease update estimated the number of people worldwide with COPD to be 328 million [4]. However, given the likely ecological fallacy [5], for a universally very high level of underdiagnosis [6], there are many questions that remain unanswered relating to the elderly with COPD. A research call for COPD in the elderly, similar to that for asthma in the elderly, is needed [7].As reviewed by LUOTO et al. [2], there were few studies quantifying the incidence of spirometrically confirmed COPD in the literature, particularly within the elderly. As exemplified in their table 5, there is a wide heterogeneity in the published estimates of incidence, varying by method, location, age and sex. Theirs is a friendly addition, given that the LLN versus fixed ratio debate appears to be more heated than ever. Within the ERJ, it is welcome that forthcoming authors report both outcomes [8]. Thus, eventually, meta-analyses based on individual patient data will help to investigate further this question and identify the more accurate of these two approaches.LUOTO et al.[2] followed for 6 years nearly a thousand individuals aged 65-100 years who had an acceptable spirometry at baseline. They participated in the longitudinal Good Aging in Skåne study, which in turn is part of the Swedish National Study on Aging and Care. Not surprisingly for an elderly population, the incidence of airflow limitation compatible with COPD was higher according to the fixed ratio definition of a forced expiratory volume in 1 s/(forced) vital capacity ratio <0.7 than with the LLN definition, as the fixed ratio underestimates airflow limitation in the young, while it is overestimated in the elderly.This type of descriptive epidemiology research could be considered simple but even such simple studies do face complex methodological challenges...

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“…However, actions for smoking control in the society have been followed by reduced smoking in many countries, and a recently published study indicates that the prevalence of COPD has decreased in parallel with changes in smoking habits in Sweden [3]. Still, the underdiagnosis is substantial; merely 20–30% of all individuals with COPD are identified by health care [4,5]. Thus, the results from studies including selected populations recruited from the health care (‘register-based studies’) must be interpreted with care, as the large underdiagnosis will affect generalizability.…”

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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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Determinants of Underdiagnosis of COPD in National and International Surveys

Cited by 347 publications

References 34 publications

Barriers to Understanding the Epidemiology of Noncommunicable Lung Disease in Sub-Saharan Africa

Barriers to Understanding the Epidemiology of Noncommunicable Lung Disease in Sub-Saharan Africa

Ageing lungs and very elderly COPD: anytime and anywhere

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

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