Smokers with respiratory symptoms but no airflow limitation, often have activity limitation, exacerbations and evidence of airway disease

Ulrik, Charlotte Suppli

doi:10.1136/ebmed-2016-110501

Cited by 1 publication

(1 citation statement)

References 6 publications

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“…32,33 From a research perspective, symptomatic smokers without AFO are an important group who require further study. 34,35 In specialist care, such patients are often prescribed inhalers for pragmatic reasons but without an evidence base to support their use. 36 However, in the absence of confirmatory trial evidence and a licence for the use of COPD-approved medication in this way, we feel it is inappropriate for such treatment to be commenced in primary care; in particular, a diagnosis of COPD should not be used to “justify” treatment in the absence of agreed AFO criteria being met.…”

Section: Discussionmentioning

confidence: 99%

COPD overdiagnosis in primary care: a UK observational study of consistency of airflow obstruction

Josephs

Culliford

Johnson

et al. 2019

npj Prim. Care Respir. Med.

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Chronic obstructive pulmonary disease (COPD) is heterogeneous, but persistent airflow obstruction (AFO) is fundamental to diagnosis. We studied AFO consistency from initial diagnosis and explored factors associated with absent or inconsistent AFO. This was a retrospective observational study using patient-anonymised routine individual data in Care and Health Information Analytics (CHIA) database. Identifying a prevalent COPD cohort based on diagnostic codes in primary care records, we used serial ratios of forced expiratory volume in 1 s to forced vital capacity (FEV1/FVC%) from time of initial COPD diagnosis to assign patients to one of three AFO categories, according to whether all (persistent), some (variable) or none (absent) were <70%. We described respiratory prescriptions over 3 years (2011–2013) and used multivariable logistic regression to estimate odds of absent or variable AFO and potential predictors. We identified 14,378 patients with diagnosed COPD (mean ± SD age 68.8 ± 10.7 years), median (IQR) COPD duration of 60 (25,103) months. FEV1/FVC% was recorded in 12,491 (86.9%) patients: median (IQR) 5 (3, 7) measurements. Six thousand five hundred and fifty (52.4%) had persistent AFO, 4507 (36.1%) variable AFO and 1434 (11.5%) absent AFO. Being female, never smoking, having higher BMI or more comorbidities significantly predicted absent and variable AFO. Despite absent AFO, 57% received long-acting bronchodilators and 60% inhaled corticosteroids (50% and 49%, respectively, in those without asthma). In all, 13.1% of patients diagnosed with COPD had unrecorded FEV1/FVC%; 11.5% had absent AFO on repeated measurements, yet many received inhalers likely to be ineffective. Such prescribing is not evidence based and the true cause of symptoms may have been missed.

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