Exploring Current Concepts and Challenges in the Identification and Management of Early-Stage COPD

Doña, Esperanza; Reinoso-Arija, Rocío; Carrasco‐Hernández, Laura; Domenech, Adolfo; Dorado, Antonio; Bodineau, José Luis López-Campos

doi:10.3390/jcm12165293

Cited by 5 publications

(3 citation statements)

References 90 publications

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“…Some authors have suggested this as a potential restrictive pattern, emphasizing the need for total lung capacity (TLC) assessment to draw definitive conclusions. Others categorize it as a non-specific spirometric pattern, but the term Preserved Ratio Impaired Spirometry (PRISm) has gained recent popularity [1,[36][37][38].…”

Section: Forced Spirometry: Flow Volume Curvementioning

confidence: 99%

Pulmonary Function Tests: Easy Interpretation in Three Steps

Ora,

Giorgino,

Bettin

et al. 2024

JCM

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Pulmonary function tests (PFTs) are pivotal in diagnosing and managing a broad spectrum of respiratory disorders. These tests provide critical insights into lung health, guiding diagnoses, assessing disease severity, and shaping patient management strategies. This review addresses the complexities and nuances inherent in interpreting PFT data, particularly in light of recent updates from the European Respiratory Society (ERS) and American Thoracic Society (ATS). These updates have refined interpretive strategies, moving away from definitive diagnostic uses of spirometry to a more probabilistic approach that better accounts for individual variability through the use of Z-scores and lower limits of normal (LLNs). Significantly, this narrative review delves into the philosophical shift in spirometry interpretation, highlighting the transition from direct clinical diagnostics to a more nuanced evaluation geared towards determining the likelihood of disease. It critiques the reliance on fixed ratios and emphasizes the need for reference values that consider demographic variables such as age, sex, height, and ethnicity, in line with the latest Global Lung Function Initiative (GLI) equations. Despite these advances, challenges remain in ensuring uniformity across different predictive models and reference equations, which can affect the accuracy and consistency of interpretations. This paper proposes a streamlined three-step framework for interpreting PFTs, aiming to unify and simplify the process to enhance clarity and reliability across various medical specialties. This approach not only aids in accurate patient assessments but also mitigates the potential for misdiagnosis and ensures more effective patient management. By synthesizing contemporary guidelines and integrating robust physiological principles, this review fosters a standardized yet flexible approach to PFT interpretation that is both scientifically sound and practically feasible.

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Section: Forced Spirometry: Flow Volume Curvementioning

confidence: 99%

Pulmonary Function Tests: Easy Interpretation in Three Steps

Ora,

Giorgino,

Bettin

et al. 2024

JCM

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show abstract

“…In addition, the current literature consistently predicts a substantial increase in the future health burden of COPD [2]. Despite clear criteria for the diagnosis of COPD, produced by the Global Initiative for Chronic Obstructive Lung Disease (GOLD), being available for two decades [3,4], underdiagnosis and overdiagnosis are still common, causing, in turn, under-or overtreatment, and determining a suboptimal disease management [5][6][7][8]. One recent meta-analysis quantified the rate of underdiagnosis in primary healthcare [9], and several studies estimated the rate of overdiagnosis [10].…”

Section: Introductionmentioning

confidence: 99%

Chronic Obstructive Pulmonary Disease Overdiagnosis and Overtreatment: A Meta-Analysis

Fiore,

Ricci,

Rosso

et al. 2023

JCM

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This meta-analysis of observational studies aimed at estimating the overall prevalence of overdiagnosis and overtreatment in subjects with a clinical diagnosis of Chronic Obstructive Pulmonary Disease (COPD). MedLine, Scopus, Embase and Cochrane databases were searched, and random-effect meta-analyses of proportions were stratified by spirometry criteria (Global Initiative for COPD (GOLD) or Lower Limit of Normal (LLN)), and setting (hospital or primary care). Forty-two studies were included. Combining the data from 39 datasets, including a total of 23,765 subjects, the pooled prevalence of COPD overdiagnosis, according to the GOLD definition, was 42.0% (95% Confidence Interval (CI): 37.3–46.8%). The pooled prevalence according to the LLN definition was 48.2% (40.6–55.9%). The overdiagnosis rate was higher in primary care than in hospital settings. Fourteen studies, including a total of 8183 individuals, were included in the meta-analysis estimating the prevalence of COPD overtreatment. The pooled rates of overtreatment according to GOLD and LLN definitions were 57.1% (40.9–72.6%) and 36.3% (17.8–57.2%), respectively. When spirometry is not used, a large proportion of patients are erroneously diagnosed with COPD. Approximately half of them are also incorrectly treated, with potential adverse effects and a massive inefficiency of resources allocation. Strategies to increase the compliance to current guidelines on COPD diagnosis are urgently needed.

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“…Accurate measurement of respiratory flow is vital for the clinical decision-making of chronic obstructive pulmonary disease (COPD) [ 1 , 2 , 3 , 4 ]. The pneumotachograph (PNT) is one of the most common respiratory flow measurement elements used for spirometers.…”

Section: Introductionmentioning

confidence: 99%

A Fast Calibration Method for Pneumotachograph with a 3L Syringe

Li,

Qiu,

Zhang

et al. 2023

Bioengineering

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The pneumotachograph (PNT), a commonly used flowmeter in pulmonary function diagnostic equipment, is the required frequency calibration to maintain high accuracy. Aiming to simplify calibration steps, we developed a fast calibration system with a commercially available 3L syringe to provide a real output flow waveform. The acquisition of the real output flow waveform is based on the reliable measurement of in-cylinder pressure and the real-time detection of plunger speed. To improve the calibration accuracy, the tapping position for measuring in-cylinder pressure was optimized by CFD dynamic-mesh updating technique. The plunger speed was obtained by tracking the handle of the plunger with a smart terminal. Then, the real output flow was corrected using a compensation model equation. The calibration system was verified by the pulmonary waveform generator that the accuracy satisfied the requirements for respiratory flow measurement according to ATS standardization. The experimental results suggest that the developed method promises the fast calibration of PNT.

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Exploring Current Concepts and Challenges in the Identification and Management of Early-Stage COPD

Cited by 5 publications

References 90 publications

Pulmonary Function Tests: Easy Interpretation in Three Steps

Pulmonary Function Tests: Easy Interpretation in Three Steps

Chronic Obstructive Pulmonary Disease Overdiagnosis and Overtreatment: A Meta-Analysis

A Fast Calibration Method for Pneumotachograph with a 3L Syringe

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