Characterisation and prognosis of undiagnosed chronic obstructive pulmonary disease patients at their first hospitalisation.

Eva Balcells,Àlvar Agustí,Antoni Ferrer,Jaume Ferrer,Elena Gimeno-Santos,Maria Antonia Ramon,Esther Rodríguez,Judith Garcia-Aymerich,Joan A Barberà,Josep M Antó,Jaume Sauleda,Marta Benet,Eva Farrero,The Pac-Copd Study Group ,Jordi De Batlle,Stefano Guerra,Joaquim Gea,Robert Rodriguez-Roisin

doi:10.1186/1471-2466-15-4

Abstract

BackgroundUnder-diagnosis of COPD is an important unmet medical need. We investigated the characteristics and prognosis of hospitalised patients with undiagnosed COPD.MethodsThe PAC-COPD cohort included 342 COPD patients hospitalised for the first time for an exacerbation of COPD (2004–2006). Patients were extensively characterised using sociodemographic, clinical and functional variables, and the cohort was followed-up through 2008. We defined “undiagnosed COPD” by the absence of any self-reported respiratory disease and regular use of any pharmacological respiratory treatment.ResultsUndiagnosed COPD was present in 34% of patients. They were younger (mean age 66 vs. 68 years, p = 0.03), reported fewer symptoms (mMRC dyspnoea score, 2.1 vs. 2.6, p < 0.01), and had a better health status (SGRQ total score, 29 vs. 40, p < 0.01), milder airflow limitation (FEV1% ref., 59% vs. 49%, p < 0.01), and fewer comorbidities (two or more, 40% vs. 56%, p < 0.01) when compared with patients with an established COPD diagnosis. Three months after hospital discharge, 16% of the undiagnosed COPD patients had stopped smoking (vs. 5%, p = 0.019). During follow-up, annual hospitalisation rates were lower in undiagnosed COPD patients (0.14 vs. 0.25, p < 0.01); however, this difference disappeared after adjustment for severity. Mortality was similar in both groups.ConclusionsUndiagnosed COPD patients have less severe disease and lower risk of re-hospitalisation when compared with hospitalised patients with known COPD.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2466-15-4) contains supplementary material, which is available to authorized users.

Highlights

Under-diagnosis of Chronic obstructive pulmonary disease (COPD) is an important unmet medical need
This study has three main findings: (1) undiagnosed patients (34% of all patients hospitalised for the first time because of an exacerbation of COPD) have milder airflow limitation, fewer symptoms, fewer comorbidities, and better Healthrelated quality of life (HRQL) when compared with patients with a previous diagnosis of COPD; (2) establishing a COPD diagnosis is associated with a positive short-term effect on smoking cessation; and (3) undiagnosed patients have a lower risk of re-hospitalisations but a similar mortality after hospitalisation when adjusted for severity of illness and covariates
This study showed that approximately one-third of patients hospitalised for the first time because of a COPD exacerbation had not been previously diagnosed

Summary

Introduction

Under-diagnosis of COPD is an important unmet medical need. We investigated the characteristics and prognosis of hospitalised patients with undiagnosed COPD. The majority of studies from general population and primary care have detected that a high proportion of individuals fulfilling COPD diagnosis criteria remain undiagnosed [3,4,5,6,7,8,9]. Two previous studies in a hospital setting highlighted that one-third of patients had never been diagnosed or treated. The current study describes the characteristics of COPD patients who were undiagnosed at the time of their first hospital admission because of a COPD exacerbation and their short- and long-term outcomes

Methods

Results

Discussion

Conclusion