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. 2023 Aug 31;15(8):4182-4197.
doi: 10.21037/jtd-23-267. Epub 2023 Jul 26.

Prevalence, diagnosis, and treatment of chronic obstructive pulmonary disease in a hospitalized lung cancer population: a single center study

Haiyan Qu #  1 , Mengjing Zhu #  1 , Chuxiao Shan #  1 , Xuan Ji  1 , Guijuan Ji  1 , Wenhui Zhang  1 , Hao Zhang  2   3 , Bi Chen  1
Affiliations

Prevalence, diagnosis, and treatment of chronic obstructive pulmonary disease in a hospitalized lung cancer population: a single center study

Haiyan Qu et al. J Thorac Dis. .

Abstract

Background: Chronic obstructive pulmonary disease (COPD) often coexists with lung cancer (LC) and has a detrimental effect on the prognosis of LC patients. Presently, there is a lack of adequate assessment regarding the management of COPD in LC patients. This study assessed the screening, prevalence, diagnosis and treatment of COPD in hospitalized LC patients and compared the management practices between two departments at our hospital.

Methods: We retrospectively assessed the data of 3,578 patients diagnosed with primary LC in the Department of Respiratory and Critical Care Medicine and the Department of Thoracic Surgery from January 2019 to December 2020. We also compared the rate of spirometry, COPD diagnosis and COPD inhalation treatment between the LC patients from both departments, the proportion of patients aware of their COPD diagnosis and adhered to inhaled therapy, and analyzed factors influencing COPD diagnosis and inhalation treatment.

Results: A total of 2,762 (77.2%) LC patients underwent spirometry, and the observed spirometry-defined COPD prevalence was 25.0% (690/2,762). The proportion of spirometry performed in the Department of Thoracic Surgery was significantly higher than in the Department of Respiratory and Critical Care Medicine (90.5% vs. 62.9%; P<0.001). The overall COPD diagnosis rate recorded in the discharge diagnosis in the 690 spirometry-defined COPD patients was 46.5% (321/690), and the COPD treatment rate during hospitalization was 45.2% (312/690). In addition, physicians from the Department of Respiratory and Critical Care Medicine had a higher diagnostic rate than surgeons from the Department of Thoracic Surgery (69.1% vs. 7.5%; P<0.001), as well as a better-standardized COPD treatment rate (60.6% vs. 18.6%; P<0.001). Further, the proportion of COPD inhalation treatment was higher among LC patients with COPD recorded in discharge diagnosis (74.8% vs. 19.5%; P<0.001), and multivariate logistic regression analysis showed that COPD recorded in discharge diagnosis significantly increased the proportion of COPD awareness post-hospitalization (P<0.001).

Conclusions: This study showed that COPD could be a frequently undiagnosed and undertreated condition among LC patients, especially those hospitalized in a surgical ward. Additionally, a discharge diagnosis of COPD may increase the rate of inhalation treatment and awareness of the condition in LC patients.

Keywords: Chronic obstructive pulmonary disease (COPD); lung cancer (LC); spirometry; treatment; underdiagnosis.

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://jtd.amegroups.com/article/view/10.21037/jtd-23-267/coif). The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Flow diagram of the study. COPD, chronic obstructive pulmonary disease; FEV1, forced expiratory volume in 1 s; FVC, forced vital capacity; RCCM, Department of Respiratory and Critical Care Medicine; TS, Department of Thoracic Surgery.
Figure 2
Figure 2
The proportion of COPD awareness and adherence to inhaled therapy. COPD, chronic obstructive pulmonary disease.
Figure 3
Figure 3
Multivariate analysis on the proportion of COPD awareness. COPD, chronic obstructive pulmonary disease; GOLD, global initiative for chronic obstructive lung disease; VC, vital capacity; FEV1, forced expiratory volume in 1 s; FEV1%pred, percent predicted FEV1; OR, odds ratio; CI, confidence interval.
See this image and copyright information in PMC

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