Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Comparative Study
. 2021 Oct 14;21(1):319.
doi: 10.1186/s12890-021-01688-z.

Underdiagnosis of obstructive lung disease: findings from the French CONSTANCES cohort

Marie-Christine Delmas  1 , Laetitia Bénézet  2 , Céline Ribet  3 , Yuriko Iwatsubo  2 , Marie Zins  3 , Rachel Nadif  4 , Nicolas Roche  4   5 , Bénédicte Leynaert  4
Affiliations
Comparative Study

Underdiagnosis of obstructive lung disease: findings from the French CONSTANCES cohort

Marie-Christine Delmas et al. BMC Pulm Med. .

Abstract

Background: The burden of undiagnosed obstructive lung disease (OLD) (mainly asthma and chronic obstructive pulmonary disease) is not fully established, and targets for corrective action are yet to be identified. We assessed the underdiagnosis of OLD and its determinants in France.

Methods: CONSTANCES is a French population-based cohort of adults aged 18-69 years at inception. We analysed data collected at inclusion in 2013-2014. Undiagnosed OLD was defined as spirometry-confirmed airflow limitation (FEV1/FVC < lower limit of normal) without prior diagnosis of asthma, chronic obstructive pulmonary disease, or bronchiectasis. Multivariate analysis was performed with weighted robust Poisson regression models to estimate the adjusted prevalence ratios (aPR) of undiagnosed OLD.

Results: Spirometry results were available for 19,398 participants. The prevalence of airflow limitation was 4.6%. Overall, 64.4% of adults with airflow limitation did not report a previous diagnosis of OLD. Individuals with high cumulative tobacco consumption (≥ 10 pack-years) (aPR: 1.72 [1.28-2.32]), without respiratory symptoms (aPR: 1.51 [1.28-1.78]), and with preserved lung function (aPR: 1.21 [1.04-1.41] for a 10-point increase in FEV1% predicted) had a higher risk of being undiagnosed. Half of symptomatic individuals with airflow limitation (45% of those with moderate to severe airflow limitation) were undiagnosed with OLD.

Conclusion: Underdiagnosis of OLD is very common among French adults, even in patients with respiratory symptoms. Efforts should be made in France to raise awareness about OLD in the general population, improve the detection of respiratory symptoms, and increase the use of spirometry among primary care professionals.

Keywords: Asthma; COPD; France; Obstructive lung disease; Underdiagnosis.

PubMed Disclaimer

Conflict of interest statement

NR reports grants or contracts from Boehringer Ingelheim, Novartis and Pfizer, consulting fees from GSK, AstraZeneca and Novartis, and Payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Boehringer Ingelheim, Novartis, GSK, AstraZeneca, Chiesi, Sanofi and Zambon. All other authors have nothing to declare.

Figures

Fig. 1
Fig. 1
Flow chart of the study population
See this image and copyright information in PMC

References

    1. GBD Chronic Respiratory Disease Collaborators. Prevalence and attributable health burden of chronic respiratory diseases, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet Respir Med. 2020;8(6):585–96. 2020. - PMC - PubMed
    1. Aaron SD, Boulet LP, Reddel HK, Gershon AS. Underdiagnosis and overdiagnosis of asthma. Am J Respir Crit Care Med. 2018;198(8):1012–1020. doi: 10.1164/rccm.201804-0682CI. - DOI - PubMed
    1. Lamprecht B, Soriano JB, Studnicka M, Kaiser B, Vanfleteren LE, Gnatiuc L, et al. Determinants of underdiagnosis of COPD in national and international surveys. Chest. 2015;148(4):971–985. doi: 10.1378/chest.14-2535. - DOI - PubMed
    1. Delmas MC, Bénézet L, Ribet C, Iwatsubo Y, Provost D, Varraso R, Zins M, Leynaert B, Nadif R, Roche N. Prevalence of asthma among adults in France, data from the Constances cohort study. Rev Mal Respir. 2021;38(8):797–806. doi: 10.1016/j.rmr.2021.05.007. - DOI - PubMed
    1. Roche N, Dalmay F, Perez T, Kuntz C, Vergnenegre A, Neukirch F, et al. Impact of chronic airflow obstruction in a working population. Eur Respir J. 2008;31(6):1227–1233. doi: 10.1183/09031936.00089607. - DOI - PubMed

Publication types