The Heterogeneity of COPD Patients in a Community-Based Practice and the Inadequacy of the Global Initiative for Chronic Obstructive Lung Disease Criteria: A Real-World Experience
Chronic obstructive pulmonary disease (COPD) is a heterogeneous disease with differing clinical presentations, which range from an asymptomatic obstructive defect on spirometry to symptomatic normal spirometry. The current standard for diagnosis requires exposure history and the presence of an obstr...
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| Published in: | Chronic obstructive pulmonary diseases Vol. 8; no. 3; pp. 396 - 407 |
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| Main Authors: | , , , , , , , , |
| Format: | Journal Article |
| Language: | English |
| Published: |
United States
COPD Foundation Inc
28-07-2021
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| Subjects: | |
| Online Access: | Get full text |
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| Summary: | Chronic obstructive pulmonary disease (COPD) is a heterogeneous disease with differing clinical presentations, which range from an asymptomatic obstructive defect on spirometry to symptomatic normal spirometry. The current standard for diagnosis requires exposure history and the presence of an obstructive ventilatory defect (forced expiratory volume in 1 second [FEV
] to forced vital capacity [FVC] ratio < 70%) on spirometry. In this real-world study, we analyzed patients with physician-diagnosed COPD, described their characteristics, and evaluated the diagnostic sensitivity of Global initiative for chronic Obstructive Lung Disease (GOLD) criteria in this population.
We retrospectively analyzed the charts of 2115 patients for eligibility. A total of 1224 patients with physician-diagnosed COPD were selected for this study. The average age was 68.4±11.5 years, with 51% being female. Of the 1224 patients, 18% did not have a history of smoking, 73% had bronchodilator testing, and a significant response of ≥12% was noted in 23% of the COPD patients. Moreover, 43% of the patients met the GOLD criteria for the diagnosis of COPD, whereas the Global Lung Function Initiative (GLI) and lower limit of normal (LLN)criteria were only able to identify 26%.
COPD-related mortality is continuing to rise, and it is currently ranked as the third leading cause of death, globally, after cardiovascular diseases and strokes. Despite this alarming statistic, COPD diagnosis is delayed in most cases and can remain undiagnosed, even in smokers. This is partly due to the restrictive GOLD diagnostic criteria, which requires the presence of FEV
/FVC ratio<70.
The recently proposed COPD Genetic Epidemiology (COPDGene
) 2019 definition for COPD will improve and enhance our ability to diagnose COPD earlier and more accurately. |
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| Bibliography: | ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 Author contributions: FOA and HAA were responsible for conception and design of the study. HAA, KMD, PSBB, RLS, MKZ, and RAI were responsible for data acquisition. FOA and HAA provided analysis of the data, interpretation of the results, and drafted the initial manuscript. FOA, FU, and NM were involved in the editing and revisions of the manuscript. All authors significantly contributed content of the article and gave final approval of the version to be published. The authors have no known conflicts of interest to disclose. |
| ISSN: | 2372-952X 2372-952X |
| DOI: | 10.15326/jcopdf.2021.0229 |