Service des Maladies Respiratoires, Hôpital Haut Lévèque, CHU de Bordeaux, Pessac, France
Centre Hospitalier de la Côte Basque, Bayonne, France.
BMJ Open Respir Res. 2024 Nov 28;11(1):e002620. doi: 10.1136/bmjresp-2024-002620.
Studies suggest that up to 70% of chronic obstructive pulmonary disease (COPD) cases globally are undiagnosed worldwide. Some of these undiagnosed patients may present with severe exacerbation and factors associated with underdiagnosis in this population are unknown. We investigated the key factors associated with underdiagnosis in two cohorts of patients hospitalised for severe COPD exacerbation at different time points.
This retrospective, multicentre study analysed data from patients hospitalised for COPD exacerbation at two independent centres during two distinct time periods: between 1 January 2017 and 31 December 2018 in the Aquitaine region and between 1 January and 31 December 2022 in Paris. Undiagnosed COPD was defined as the absence of pulmonary function testing before the index exacerbation. Multivariate logistic regression was used to evaluate associations between underdiagnosis and patient characteristics.
Among the 424 patients, 93 (21.9%) were undiagnosed before hospitalisation, with a stable rate over time (22% in 2017-2018 and 21% in 2022). Multivariate analysis revealed that underdiagnosis was related to higher forced expiratory volume in one second (FEV; adjusted OR (aOR)=1.02, p=0.043) and female sex (aOR=1.91, p=0.015). Patients with undiagnosed COPD had significantly lower rehospitalisation and mortality rates. After the initial severe exacerbation, higher mortality was associated with a higher Charlson Comorbidity Index (HR=1.24, p=0.007) and older age (HR=1.05, p=0.008).
This retrospective, multicentre study demonstrated that about 20% of patients admitted with severe exacerbation were undiagnosed for COPD. Higher FEV and female sex were associated with underdiagnosis, emphasising the need for special attention to this population. These findings highlight the need to improve training and access to spirometry and develop new diagnostic tools that facilitate earlier detection and management of COPD.
研究表明，在全球范围内，高达 70%的慢性阻塞性肺疾病（COPD）患者未被诊断。其中一些未被诊断的患者可能会出现严重的恶化，而该人群中与诊断不足相关的因素尚不清楚。我们研究了两个 COPD 严重恶化住院患者队列中与诊断不足相关的关键因素，这些患者分别在两个不同的时间点入院。
这项回顾性、多中心研究分析了在两个不同时间点在两个独立中心因 COPD 恶化住院的患者的数据：2017 年 1 月 1 日至 2018 年 12 月 31 日在阿基坦地区，2022 年 1 月 1 日至 2022 年 12 月 31 日在巴黎。未诊断的 COPD 定义为在指数恶化之前没有进行肺功能测试。使用多变量逻辑回归评估了诊断不足与患者特征之间的关联。
在 424 名患者中，93 名（21.9%）在住院前未被诊断，且随时间变化稳定（2017-2018 年为 22%，2022 年为 21%）。多变量分析显示，诊断不足与更高的一秒用力呼气量（FEV；调整后的比值比（aOR）=1.02，p=0.043）和女性性别（aOR=1.91，p=0.015）相关。未诊断为 COPD 的患者再住院和死亡率显著降低。在首次严重恶化后，更高的死亡率与更高的 Charlson 合并症指数（HR=1.24，p=0.007）和更高的年龄（HR=1.05，p=0.008）相关。
这项回顾性、多中心研究表明，约 20%因严重恶化而住院的患者未被诊断为 COPD。更高的 FEV 和女性性别与诊断不足相关，这强调了对该人群的特别关注。这些发现强调了需要改善培训和肺功能检查的可及性，并开发新的诊断工具，以促进 COPD 的早期发现和管理。
