Abstract
A hallmark of the diagnosis of chronic obstructive pulmonary disease (COPD) is the measurement of post-bronchodilator (post-BD) airflow obstruction (AO) by spirometry, but spirometry is not enough for the provision of a clinical diagnosis. In the majority of previous epidemiological studies, COPD diagnosis has been based on spirometry and a few clinical characteristics. The aim of our study was to identify outcomes in patients newly diagnosed with airflow obstruction (AO) based on a diagnostic work-up conducted as part of a population-based cross-sectional study in North-Western Russia. Spirometry was performed before (pre-BD) and after BD administration, and AO was defined using the FEV1/FVC <0.70 and FEV1/FVC <lower limit of normal cut-off values. Relevant symptoms were recorded. Participants with AO identified at baseline were then examined by a pulmonologist, including a clinical examination and second spirometry with BD test. Of the 102 participants with post-BD AO in the initial assessment, only 60.8% still had AO identified at the second examination; among these patients, the following final diagnoses were reported: COPD (n = 41), asthma (n = 5), asthma–COPD overlap syndrome (ACOS) (n = 4) and likely ACOS (n = 5). Of the 65 participants with pre-BD AO, 23.1% had post-BD AO at the second assessment, and these patients had been diagnosed with COPD (n = 12), asthma (n = 1), ACOS (n = 1), likely ACOS (n = 1). Serial spirometric assessments complemented by a comprehensive clinical evaluation are recommended in new epidemiological studies.
Highlights
Chronic obstructive pulmonary disease (COPD) is, at present, the third most prevalent cause of death in developed countries and associated with increasing mortality in developing countries, this conditions is still not well recognized by either the general public or physicians, and over half of chronic obstructive pulmonary disease (COPD) cases go undiagnosed.[1]
The FEV1/forced vital capacity (FVC) ratio measured during the baseline spirometry was lower among the 62 participants who had post-BD airflow obstruction (AO) identified both during the first and second spirometry measurements than among the 40 participants without AO identified during the second spirometry measurement (FEV1/FVC = 0.60 [95% CI 0.57–0.65) and FEV1/FVC = 0.66 [95% CI 0.65–0.67], correspondently, p < 0.01)
We found that 60% of those that shifted diagnosis from obstructive to non-obstructive were labeled as Global Initiative of Chronic Obstructive Lung Disease (GOLD) class 1 before and another 37,5% as GOLD class 2
Summary
Chronic obstructive pulmonary disease (COPD) is, at present, the third most prevalent cause of death in developed countries and associated with increasing mortality in developing countries, this conditions is still not well recognized by either the general public or physicians, and over half of COPD cases go undiagnosed.[1]. It should, be emphasized that the aim of this smoking indicated that an individual smoked one pack of cigarettes The RESPECT study population differs from the overall population of the northwestern region of Russia in terms of age and sex.[16] It has more women than the average population in the northwestern region of Russia (68.2 vs 55.3%) and less current and cigarettes) daily for one year. Treatment and exacerbation frequency of obstructive disease were assessed at enrollment
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