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Observational Study
. 2015 Jan 17:15:4.
doi: 10.1186/1471-2466-15-4.

Characterisation and prognosis of undiagnosed chronic obstructive pulmonary disease patients at their first hospitalisation

Eva Balcells, Elena Gimeno-Santos, Jordi de Batlle, Maria Antonia Ramon, Esther Rodríguez, Marta Benet, Eva Farrero, Antoni Ferrer, Stefano Guerra, Jaume Ferrer, Jaume Sauleda, Joan A Barberà, Àlvar Agustí, Robert Rodriguez-Roisin, Joaquim Gea, Josep M Antó, Judith Garcia-Aymerich  1 ; PAC-COPD Study Group
Collaborators, Affiliations
Observational Study

Characterisation and prognosis of undiagnosed chronic obstructive pulmonary disease patients at their first hospitalisation

Eva Balcells et al. BMC Pulm Med. .

Abstract

Background: Under-diagnosis of COPD is an important unmet medical need. We investigated the characteristics and prognosis of hospitalised patients with undiagnosed COPD.

Methods: The PAC-COPD cohort included 342 COPD patients hospitalised for the first time for an exacerbation of COPD (2004-2006). Patients were extensively characterised using sociodemographic, clinical and functional variables, and the cohort was followed-up through 2008. We defined "undiagnosed COPD" by the absence of any self-reported respiratory disease and regular use of any pharmacological respiratory treatment.

Results: Undiagnosed COPD was present in 34% of patients. They were younger (mean age 66 vs. 68 years, p = 0.03), reported fewer symptoms (mMRC dyspnoea score, 2.1 vs. 2.6, p < 0.01), and had a better health status (SGRQ total score, 29 vs. 40, p < 0.01), milder airflow limitation (FEV1% ref., 59% vs. 49%, p < 0.01), and fewer comorbidities (two or more, 40% vs. 56%, p < 0.01) when compared with patients with an established COPD diagnosis. Three months after hospital discharge, 16% of the undiagnosed COPD patients had stopped smoking (vs. 5%, p = 0.019). During follow-up, annual hospitalisation rates were lower in undiagnosed COPD patients (0.14 vs. 0.25, p < 0.01); however, this difference disappeared after adjustment for severity. Mortality was similar in both groups.

Conclusions: Undiagnosed COPD patients have less severe disease and lower risk of re-hospitalisation when compared with hospitalised patients with known COPD.

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Figures

Figure 1
Figure 1
Design and study population. *Until Dec 31, 2007 (re-hospitalisations) and Dec 31, 2008 (mortality).
Figure 2
Figure 2
Short-term effects of a new COPD diagnosis on smoking cessation. P-values were obtained from a logistic regression model with active smoking as the outcome and the interaction between diagnosis status and time (period) included as explanatory variables. For further explanations, see the main manuscript text.
Figure 3
Figure 3
Kaplan-Meier curves show the cumulative hospitalisation-free rate (panel A) and survival rate (panel B) according to previous COPD diagnosis.
See this image and copyright information in PMC

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Pre-publication history
    1. The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1471-2466/15/4/prepub

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