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
Multicenter Study
. 2024 Nov 28;11(1):e002620.
doi: 10.1136/bmjresp-2024-002620.

Factors associated with undiagnosed COPD in patients hospitalised for severe COPD exacerbation

Marina Guecamburu  1   2   3 , Emilie Klein  4 , Guillaume Verdy  5 , Cécilia Nocent-Ejnaini  2 , Julie Macey  4 , Laurent Portel  3 , Léo Grassion  4 , Thibaud Soumagne  6 , Maéva Zysman  4   7
Affiliations
Multicenter Study

Factors associated with undiagnosed COPD in patients hospitalised for severe COPD exacerbation

Marina Guecamburu et al. BMJ Open Respir Res. .

Abstract

Background: Studies suggest that up to 70% of chronic obstructive pulmonary disease (COPD) cases globally are undiagnosed worldwide. Some of these undiagnosed patients may present with severe exacerbation and factors associated with underdiagnosis in this population are unknown. We investigated the key factors associated with underdiagnosis in two cohorts of patients hospitalised for severe COPD exacerbation at different time points.

Methods: This retrospective, multicentre study analysed data from patients hospitalised for COPD exacerbation at two independent centres during two distinct time periods: between 1 January 2017 and 31 December 2018 in the Aquitaine region and between 1 January and 31 December 2022 in Paris. Undiagnosed COPD was defined as the absence of pulmonary function testing before the index exacerbation. Multivariate logistic regression was used to evaluate associations between underdiagnosis and patient characteristics.

Results: Among the 424 patients, 93 (21.9%) were undiagnosed before hospitalisation, with a stable rate over time (22% in 2017-2018 and 21% in 2022). Multivariate analysis revealed that underdiagnosis was related to higher forced expiratory volume in one second (FEV1; adjusted OR (aOR)=1.02, p=0.043) and female sex (aOR=1.91, p=0.015). Patients with undiagnosed COPD had significantly lower rehospitalisation and mortality rates. After the initial severe exacerbation, higher mortality was associated with a higher Charlson Comorbidity Index (HR=1.24, p=0.007) and older age (HR=1.05, p=0.008).

Conclusion: This retrospective, multicentre study demonstrated that about 20% of patients admitted with severe exacerbation were undiagnosed for COPD. Higher FEV1 and female sex were associated with underdiagnosis, emphasising the need for special attention to this population. These findings highlight the need to improve training and access to spirometry and develop new diagnostic tools that facilitate earlier detection and management of COPD.

Keywords: COPD Exacerbations; COPD epidemiology.

PubMed Disclaimer

Conflict of interest statement

Competing interests: MG, EK, GV and LP have no conflicts of interest to disclose. CN-E reports grants and personal fees from GSK, Sanofi, AstraZeneca, Chiesi, ALK and Menarini outside the submitted work. JM has no conflicts of interest to declare. LG has no conflict of interest to declare related to the present work. He received grants from AADAIRC. He received speaker or advisory board fees from GSK, Asten, Air Liquide Medical System, Sanofi Genzyme, SOS Oxygène, AstraZeneca, ASV, Boehringer, VIVISOL and ResMed and support for attending the meeting from SOS Oxygène, Alize Santé and Asten. TS reports personal fees from Menarini, Sanofi, Chiesi, AstraZeneca, GSK outside the submitted work. MZ reports grants and personal fees from Menarini, personal fees from Sanofi, personal fees from Chiesi, personal fees from AstraZeneca, personal fees from CSL Behring and personal fees from GSK outside the submitted work, grants from AVAD, grants from FRM.

Figures

Figure 1
Figure 1. Flow chart. COPD, chronic obstructive pulmonary disease; PMSI, Programme de Médicalisation des Systèmes d’Information.
Figure 2
Figure 2. Forest plot of multivariate logistic regression analysis of association between patient characteristics and undiagnosed chronic obstructive pulmonary disease. aOR, adjusted OR; FEV1, forced expiratory volume in one second.
Figure 3
Figure 3. Survival according to delay in the whole cohort (A) and after the first severe chronic obstructive pulmonary disease (COPD) exacerbation (B). aOR, adjusted OR.
Figure 4
Figure 4. Forrest plot of cox model of factors associated with mortality in the whole cohort and among patients with first severe COPD exacerbation. COPD, chronic obstructive pulmonary disease; FEV1, forced expiratory volume in one second.
See this image and copyright information in PMC

References

    1. Chen X, Zhou C-W, Fu Y-Y, et al. Global, regional, and national burden of chronic respiratory diseases and associated risk factors, 1990-2019: Results from the Global Burden of Disease Study 2019. Front Med (Lausanne) 2023;10:1066804. doi: 10.3389/fmed.2023.1066804. - DOI - PMC - PubMed
    1. Global Initiative for Chronic Obstructive Lung Disease GOLD report. 2023. [07-Jan-2023]. https://goldcopd.org/2023-gold-report-2/ Available. Accessed.
    1. Seemungal TA, Donaldson GC, Bhowmik A, et al. Time course and recovery of exacerbations in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med . 2000;161:1608–13. doi: 10.1164/ajrccm.161.5.9908022. - DOI - PubMed
    1. Halpin DMG, Decramer M, Celli BR, et al. Effect of a single exacerbation on decline in lung function in COPD. Respir Med. 2017;128:85–91. doi: 10.1016/j.rmed.2017.04.013. - DOI - PubMed
    1. Camac ER, Voelker H, Criner GJ. COPD Clinical Research Network and the Canadian Institutes of Health Research. Impact of COPD exacerbations leading to hospitalization on general and disease-specific quality of life. Respir Med. 2021;186:106526. doi: 10.1016/j.rmed.2021.106526. - DOI - PubMed

Publication types

LinkOut - more resources