Division of Pulmonary, Allergy and Critical Care, Harron Lung Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States.
Department of Epidemiology, Colorado School of Public Health, Anschutz Medical Campus, University of Colorado, Aurora, CO, United States.
Respir Med. 2023 Mar;208:107126. doi: 10.1016/j.rmed.2023.107126. Epub 2023 Jan 28.
Recent evidence suggests a high prevalence of undiagnosed chronic obstructive pulmonary disease (COPD). These individuals are at risk of exacerbations and delayed treatment. We analyzed an at-risk population for the prevalence of abnormal spirometry to provide clarity into who should undergo early spirometry.
We analyzed data from the COPDGene study. Participants with ≥10 pack-years of smoking were included. Individuals with self-reported or physician-diagnosed COPD, asthma, chronic bronchitis, emphysema and/or were on inhalers were excluded. Parsimonious multivariable logistic regression models identified factors associated with abnormal spirometry, defined as either airflow obstruction (AFO) or preserved ratio impaired spirometry. Variables were selected for the final model using a stepwise backward variable elimination process which minimized Akaike information criterion (AIC). Similarly, during the 5-year follow-up period, we assessed factors associated with incident diagnosis of COPD.
Of 5055 individuals, 1064 (21%) had undiagnosed AFO. Age, pack-years, current smoking and a history of acute bronchitis were associated with AFO while body mass index, female sex, and Black race were inversely associated. Among 2800 participants with 5-year follow-up, 532 (19%) had an incident diagnosis of COPD. Associated risk factors included mMRC ≥2, chronic productive cough, respiratory exacerbations during the follow-up period, and abnormal spirometry. Age was inversely associated.
The prevalence of undiagnosed COPD is high in at-risk populations. We found multiple factors associated with undiagnosed COPD and incident diagnosis of COPD at follow up. These results can be used to identify those at risk for undiagnosed COPD to facilitate earlier diagnosis and treatment.
最近的证据表明，未确诊的慢性阻塞性肺疾病（COPD）患病率很高。这些人有加重和延迟治疗的风险。我们分析了高危人群的异常肺活量测定结果，以明确哪些人应该早期进行肺活量测定。
我们分析了 COPDGene 研究的数据。纳入至少有 10 包年吸烟史的参与者。排除有自我报告或医生诊断的 COPD、哮喘、慢性支气管炎、肺气肿和/或正在使用吸入器的个体。简约多元逻辑回归模型确定了与异常肺活量测定相关的因素，定义为气流阻塞（AFO）或保留比受损的肺活量测定。使用逐步向后变量消除过程选择最终模型中的变量，该过程将 Akaike 信息准则（AIC）最小化。同样，在 5 年随访期间，我们评估了与 COPD 新诊断相关的因素。
在 5055 名参与者中，有 1064 名（21%）患有未确诊的 AFO。年龄、包年、当前吸烟和急性支气管炎史与 AFO 相关，而体重指数、女性和黑人种族则呈负相关。在有 5 年随访的 2800 名参与者中，有 532 名（19%）新诊断为 COPD。相关的危险因素包括 mMRC≥2、慢性湿性咳嗽、随访期间的呼吸恶化以及异常的肺活量测定。年龄呈负相关。
高危人群中未确诊 COPD 的患病率很高。我们发现了与未确诊 COPD 和随访期间新诊断的 COPD 相关的多个因素。这些结果可用于识别未确诊 COPD 的高危人群，以促进早期诊断和治疗。
