Geographical Variations in the Prevalence of COPD in Spain: Relationship to Smoking, Death Rates and other Determining Factors

Soriano, Joan B.; Miravitlles, Marc; Borderías, Luis; Durán-Tauleria, Enric; Río, Francisco García; Martínez, Jorge L.; Montemayor, Teodoro; Muñoz, Luis; Piñeiro, Luis; Sánchez, Guadalupe; Serra, Joan; Soler-Cataluña, Juan José; Torres, Antoni; Viejo, José Luís; Sobradillo-Peña, Víctor; Ancochea, Julio

doi:10.1016/s1579-2129(11)60005-0

Cited by 31 publications

(19 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…1 COPD has been estimated to occur in up to 25% of the population aged 40 years and older [1][2][3] ; however, both overdiagnosis and underdiagnosis pose challenges in daily practice, resulting in inappropriate patient management. [2][3][4][5][6][7][8][9][10] COPD guidelines recommend the use of a low ratio of forced expiratory volume in 1 second to forced vital capacity (FEV 1 /FVC) to establish the diagnosis in patients with chronic respiratory symptoms or those at risk. 1,11,12 There is currently no consensus on the best criteria to be used for the spirometric confirmation of a clinical diagnosis of COPD.…”

Section: Introductionmentioning

confidence: 99%

“…One measure is the FEV 1 /FVC fixed ratio of less than 0.7, alone or in combination with a low FEV 1 set at a value less than 80% of predicted; the combination comprises Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage 2 or worse disease. The other measure is the FEV 1 /FVC ratio below the 5th percentile, in other Wouter van Dijk, MD, PhD 1,2 Wan Tan, MD 3 words, below the lower limit of normal (LLN). 1,[11][12][13][14][15][16][17] Prevalence studies have shown discordance between the fixed ratio and LLN, suggesting potential overdiagnosis by the former or underdiagnosis by the latter.…”

Section: Introductionmentioning

confidence: 99%

“…1,[11][12][13][14][15][16][17] Prevalence studies have shown discordance between the fixed ratio and LLN, suggesting potential overdiagnosis by the former or underdiagnosis by the latter. 3,4,8,18,19 This controversy persists because of the absence of a reference standard for the diagnosis of COPD. 19 The associations of the 2 criteria with clinical outcomes have been assessed in a few studies, with unclear results on the relative superiority of 1 criterion over the other when it comes to their relationship with different clinical outcomes.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Clinical Relevance of Fixed Ratio vs Lower Limit of Normal of FEV1/FVC in COPD: Patient-Reported Outcomes From the CanCOLD Cohort

Dijk

Tan

et al. 2015

The Annals of Family Medicine

103

View full text Add to dashboard Cite

PURPOSEThe way in which spirometry is interpreted can lead to misdiagnosis of chronic obstructive pulmonary disease (COPD) resulting in inappropriate treatment. We compared the clinical relevance of 2 criteria for defining a low ratio of forced expiratory volume in 1 second to forced vital capacity (FEV 1 /FVC): the fixed ratio and the lower limit of normal. METHODSWe analyzed data from the cross-sectional phase of the populationbased Canadian Cohort of Obstructive Lung Disease (CanCOLD) study. We determined associations of the spirometric criteria for airflow limitation with patientreported adverse outcomes, including respiratory symptoms, disability, health status, exacerbations, and cardiovascular disease. Sensitivity analyses were used to explore the impact of age and severity of airflow limitation on these associations. RESULTSWe analyzed data from 4,882 patients aged 40 years and older. The prevalence of airflow limitation was 17% by fixed ratio and 11% by lower limit of normal. Patients classified as having airflow limitation by fixed ratio only had generally small, nonsignificant increases in the odds of adverse outcomes. Patients having airflow limitation based on both fixed ratio and lower limit of normal had larger, significant increases in odds. But strongest associations were seen for patients who had airflow limitation by both fixed ratio and lower limit of normal and also had a low FEV 1 , defined as one less than 80% of the predicted value. CONCLUSIONSOur results suggest that use of the fixed ratio alone may lead to misdiagnosis of COPD. A diagnosis established by both a low FEV 1 /FVC (according to fixed ratio and/or lower limit of normal) and a low FEV 1 is strongly associated with clinical outcomes. Guidelines should be reconsidered to require both spirometry abnormalities so as to reduce overdiagnosis of COPD.

show abstract

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Clinical Relevance of Fixed Ratio vs Lower Limit of Normal of FEV1/FVC in COPD: Patient-Reported Outcomes From the CanCOLD Cohort

Dijk

Tan

et al. 2015

The Annals of Family Medicine

103

View full text Add to dashboard Cite

show abstract

“…For example, cystic fibrosis (CF) is a chronic and debilitating disorder that often results in premature morbidity and mortality, but it only affects an estimated 30,000 individuals. In addition, regional variability exists in the prevalence of some pulmonary disorders, including interstitial lung diseases (27)(28)(29). The low prevalence and geographical heterogeneity of these diseases may hamper the ability to enroll these patients into pragmatic clinical trials.…”

Section: Identification Of Patients and Therapies For Studiesmentioning

confidence: 99%

Comparative Effectiveness Research in Lung Diseases and Sleep Disorders

Lieu

Krishnan

et al. 2011

Am J Respir Crit Care Med

View full text Add to dashboard Cite

The Division of Lung Diseases of the National Heart, Lung, and Blood Institute (NHLBI) held a workshop to develop recommendations on topics, methodologies, and resources for comparative effectiveness research (CER) that will guide clinical decision making about available treatment options for lung diseases and sleep disorders. A multidisciplinary group of experts with experience in efficacy, effectiveness, implementation, and economic research identified (a) what types of studies the domain of CER in lung diseases and sleep disorders should include, (b) the criteria and process for setting priorities, and (c) current resources for and barriers to CER in lung diseases. Key recommendations were to (1) increase efforts to engage stakeholders in developing CER questions and study designs; (2) invest in further development of databases and other infrastructure, including efficient methods for data sharing; (3) make full use of a broad range of study designs; (4) increase the appropriate use of observational designs and the support of methodologic research; (5) ensure that committees that review CER grant applications include persons with appropriate perspective and expertise; and (6) further develop the workforce for CER by supporting training opportunities that focus on the methodologic and practical skills needed.

show abstract

“…Data only relates to Lisbon, while high heterogeneity is seen in other national studies with multiple centres and areas. 15,16 Given that the fieldwork was carried out in 2008, an update will be deemed necessary in due course. Of interest are the high frequency of airflow limitation in never-smokers, to exploring other centres within the Portuguese geography, and local determinants of COPD in women, 17 all are potential avenues for future research.…”

mentioning

confidence: 99%