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. 2023 Mar:208:107126.
doi: 10.1016/j.rmed.2023.107126. Epub 2023 Jan 28.

Prevalence of abnormal spirometry in individuals with a smoking history and no known obstructive lung disease

Thuonghien V Tran  1 , Gregory L Kinney  2 , Alejandro Comellas  3 , Karin F Hoth  4 , Arianne K Baldomero  5 , A James Mamary  6 , Jeffrey L Curtis  7 , Nicola Hanania  8 , Richard Casaburi  9 , Kendra A Young  2 , Victor Kim  6 , Barry Make  10 , Emily S Wan  11 , Alejandro A Diaz  12 , John Hokanson  2 , James D Crapo  10 , Edwin K Silverman  13 , Surya P Bhatt  14 , Elizabeth Regan  15 , Spyridon Fortis  16 ; COPDGene® Investigators – Core Units; COPDGene® Investigators – Clinical Centers
Collaborators, Affiliations

Prevalence of abnormal spirometry in individuals with a smoking history and no known obstructive lung disease

Thuonghien V Tran et al. Respir Med. 2023 Mar.

Abstract

Introduction: 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.

Methods: 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.

Results: 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.

Conclusions: 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.

Keywords: Chronic obstructive pulmonary disease; Diagnosis.

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Conflict of interest statement

Declaration of competing interest Alejandro Comellas has consulted for GSK and VIDA Diagnostics. Arianne K. Baldomero is supported by the NIHNational Center for Advancing Translational Sciences Grants KL2TR002492 and UL1TR002494. Jeffrey L. Curtis is supported by R01 HL144718, R01 HL144849, U01 HL137880, and I01 CX001969 and has consulted for AstraZeneca PLC, Novartis AG, and CSL Behring LLC. Richard Casaburi has received consultant fees or honoraria from Boehringer Ingelheim, Glaxo Smith Kline and Inogen. Victor Kim has consulted for Boehringer Ingelheim, Gala Therapeutics and AstraZeneca and received personal fees from American Board of Internal Medicine. Alejandro A. Diaz is supported by NIH grants R01-HL133137, R01-HL14986; has reported speaker fees from Boehringer Ingelheim, outside the submitted work. Edwin K. Silverman has received grant support from GlaxoSmithKline and Bayer. Surya P. Bhatt is supported by NIH Grants R01HL151421, R21EB027891, and UG3HL155806 and he has served on advisory boards for Boehringer Ingelheim and Sanofi/Regeneron. Spyridon Fortis has received grants from American Thoracic Society and Fisher &Paykel and served as a consultant for Genentech. The rest of the authors have no relevant conflicts to disclose.

Figures

Figure 1.
Figure 1.
Flowchart of study population Abbreviations: AFO = airflow obstruction, COPD = chronic obstructive pulmonary disease, PY = pack-years, PRISm = preserved ratio impaired spirometry
Figure 2.
Figure 2.
Participants with and without an incident diagnosis of COPD but at least one exacerbation between enrollment and 5-year follow-up stratified by spirometry at 5-year follow-up. Abbreviations: AFO = airflow obstruction, PRISm = preserved ratio impaired spirometry
See this image and copyright information in PMC

References

    1. Kochanek KD, et al., Mortality in the United States, 2016. NCHS Data Brief, 2017(293): p. 1–8. - PubMed
    1. GOLD G.I.f.C.O.L.D. 2021 Global Strategy for Prevention, Diagnosis and Management of COPD. 2021. [cited 2021 March 26th]; Available from: https://goldcopd.org/.
    1. Riley CM and Sciurba FC, Diagnosis and Outpatient Management of Chronic Obstructive Pulmonary Disease: A Review. JAMA, 2019. 321(8): p. 786–797. - PubMed
    1. Welte T, Vogelmeier C, and Papi A, COPD: early diagnosis and treatment to slow disease progression. Int J Clin Pract, 2015. 69(3): p. 336–49. - PubMed
    1. Colak Y, et al., Prognosis of asymptomatic and symptomatic, undiagnosed COPD in the general population in Denmark: a prospective cohort study. Lancet Respir Med, 2017. 5(5): p. 426–434. - PubMed

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