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. 2010 Jun;137(6):1345-53.
doi: 10.1378/chest.09-2681. Epub 2010 Apr 2.

Do symptoms predict COPD in smokers?

Jill A Ohar  1 , Alireza Sadeghnejad, Deborah A Meyers, James F Donohue, Eugene R Bleecker
Affiliations

Do symptoms predict COPD in smokers?

Jill A Ohar et al. Chest. 2010 Jun.

Abstract

Background: The US Preventive Services Task Force recommends against spirometry in the absence of symptoms. However, as much as 50% of COPD cases in the United States remain undiagnosed.

Methods: Report of symptoms, smoking history, and spirometric data were collected from subjects screened for a work-related medical evaluation (N = 3,955). Prevalence of airflow obstruction and respiratory symptoms were assessed. Sensitivity, specificity, positive and negative predictive values, and relative risks of predicting symptoms and smoking history for COPD were calculated.

Results: Forty-four percent of smokers in our sample had airways obstruction (AO). Of these, 36% reported a diagnosis of or treatment for COPD. Odds ratio (95% CI) for AO with smoking (> or = 20 pack-years) was 3.73 (3.12- 4.45), 1.98 (1.73-2.27) for cough, 1.79 (1.55-2.08) for dyspnea, 1.95 (1.70-2.34) for sputum, and 2.59 (2.26-2.97) for wheeze. Respiratory symptoms were reported by 92% of smokers with AO, 86% smokers with restriction, 76% smokers with normal spirometry, and 73% of nonsmokers. Sensitivity (92% vs 90%), specificity (19% vs 22%), positive (47% vs 40%) and negative (75% vs 80%) predictive values for the presence of one or more symptoms were similar between smokers and all subjects.

Conclusions: COPD is underdiagnosed in the United States. Symptoms are frequent in subjects with AO and increase their risk for COPD, but add little beyond age and smoking history to the predictive value of spirometry. In view of the high prevalence of symptoms and their poor predictive value, a simpler and more effective approach would be to screen older smokers.

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Figures

Figure 1.
Figure 1.
Long-term smokers with a remote history of lung cancer and spirometric evidence of airflow obstruction were more likely to have received a diagnosis of COPD than long-term smokers with airflow obstruction and no history of lung cancer. Dxed = diagnosed; Hx = history.
Figure 2.
Figure 2.
COPD was frequently underdiagnosed in long-term smokers. Dx = diagnosis. See Figure 1 legend for expansion of the other abbreviation.
Figure 3.
Figure 3.
COPD was missed more frequently in the cohort of smokers and nonsmokers than in the subset of long-term smokers alone. See Figure 1 legend for expansion of abbreviation.
See this image and copyright information in PMC

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