Undiagnosed Chronic Obstructive Pulmonary Disease Research Articles

From Headache to Altered Consciousness: Headache Attributed to Hypoxia and/or Hypercapnia in a Smoker With Undiagnosed Chronic Obstructive Pulmonary Disease

From Headache to Altered Consciousness: Headache Attributed to Hypoxia and/or Hypercapnia in a Smoker With Undiagnosed Chronic Obstructive Pulmonary Disease

Unlikely any benefit from population wide case-finding strategies to identify people with undiagnosed asthma or chronic obstructive pulmonary disease.

Unlikely any benefit from population wide case-finding strategies to identify people with undiagnosed asthma or chronic obstructive pulmonary disease.

Association between lung function and sleep disorder symptoms in a community-based multi-site case-finding study.

Obstructive airway disease is associated with sleep disturbances. We aimed to assess the relationship between lung function and sleep disorder symptoms using cross-sectionally collected data between March 2017 and August 2021 from the Undiagnosed Chronic Obstructive Pulmonary Disease and Asthma Population study, a prospective community-based multi-site case-finding study. Undiagnosed Chronic Obstructive Pulmonary Disease and Asthma Population study participants with respiratory symptoms but without diagnosed lung disease who completed spirometry and the Global Sleep Assessment Questionnaire were included. We conducted multivariate linear regression models for forced expiratory volume in 1 s, forced vital capacity and forced expiratory volume in 1 s/forced vital capacity by Global Sleep Assessment Questionnaire responses adjusted for confounders. The same models were employed to examine respiratory symptoms, as reported on the St George's Respiratory Questionnaire and Chronic Obstructive Pulmonary Disease Assessment Test, by Global Sleep Assessment Questionnaire responses. Logistic regression models were used to assess the association of undiagnosed obstructive airway disease with sleep symptoms. Amongst 2093 adults included in the study, 48.3% were female and the median age was 63 years (interquartile range 53-72). Two-hundred and five (9.79%) subjects met spirometry criteria for undiagnosed chronic obstructive pulmonary disease, and 191 (9.13%) for undiagnosed asthma. There were no significant associations between spirometry measures and sleep symptoms (p > 0.5), controlling for age, sex, body mass index, smoking and comorbidities. Those with undiagnosed asthma were more likely to report insomnia "at least sometimes" versus "never" (odds ratio 2.58, 95% confidence interval: 1.27-6.19, p = 0.02). Respiratory symptoms were associated with sleep symptoms, with significant (p < 0.05) increases in St George's Respiratory Questionnaire and Chronic Obstructive Pulmonary Disease Assessment Test scores in those reporting most sleep symptoms. Overall, we found an association between undiagnosed asthma and insomnia, and between respiratory and sleep disorder symptoms.

Cardio-pulmonary exercise testing aids chronic obstructive pulmonary disease diagnosis in the perioperative evaluation of patients undergoing radical cystectomy

Chronic Obstructive Pulmonary Disease (COPD) is a chronic lung condition distinguished by structural changes and mucus build-up which causes dyspnoea. COPD is universally diagnosed by a spirometry test. A Forced Expiratory Volume in one second (FEV1)/Forced Vital Capacity (FVC) of &lt;0.7, is often used to justify COPD diagnosis (Hopkinson et al., 2019, Brit Med J, 366, l4486). Reliance on spirometry tests alone may only highlight airway obstruction and not identify other consequences of COPD like impaired gas exchange which is implicated in the development of postoperative pulmonary complications. Cardio-pulmonary exercise testing (CPET) provides a more detailed look into the pathophysiology of COPD and is routinely used in perioperative settings to determine a patient’s fitness for surgery. The aims of this study were to 1) identify the number of bladder cancer patients with undiagnosed COPD, and 2) compare COPD-related CPET variables between bladder cancer patients medically diagnosed with COPD (COPDMED) who had the potential to be diagnosed at the time of CPET (COPDCPET) and those without COPD (non-COPD). All testing was performed per the American Thoracic Society/American College of Chest Physicians guidelines (2003, Am J Resp Crit Care Med, 167, 211-277). COPD-related CPET variables recorded included Minute Ventilation (V̇E; L·min-1), Peak Oxygen Consumption (V̇O2peak; mL·kg-1·min-1), the Anaerobic Threshold (AT; mL·kg-1·min-1), Ventilatory Equivalence for Carbon Dioxide (V̇E/V̇CO2), Breathing Reserve (BR; %). Eighty-two patients with bladder cancer (COPDMED [n=9], non-COPD [n=73]) underwent preoperative spirometry and CPET. In the non-COPD patients, 21 (29%) had an FEV1/FVC&lt; 0.7, indicative of COPD and thus groups as COPDCPET. Within the COPDCPET group, 8 (40%) had an FEV1 between 50-70% of predicted which indicated moderate COPD. There was no difference found in all CPET variables measured between COPDMED and COPDCPET (P &gt; 0.05). When COPDMED and COPDCPET were combined and compared against the non-COPD, there was a difference found in their median (95% CI) V̇Erest (13.3 [12.3-14.2] vs 11.75 [11.2-12.6] L·min-1, P = 0.02, g = 0.28). V̇O2peak (14.95 [13.64-18.12] vs 17.16 [16.35-19.11] mL·kg-1·min-1, P = 0.049, g = 0.29). V̇E/V̇CO2 at the AT (38 [36-40] vs 36 [34-37], P = 0.04, g = 0.49). There was also a difference in mean +/- SD BR (36 +/- 17 % vs 47 +/- 14 %, P = 0.004, g = 0.69). This study demonstrates the underdiagnosis of COPD in perioperative settings. Future research should assess the use of targeted COPD optimisation preoperatively.

Early Diagnosis and Treatment of COPD and Asthma — A Randomized, Controlled Trial

BackgroundMany persons with chronic obstructive pulmonary disease (COPD) or asthma have not received a diagnosis, so their respiratory symptoms remain largely untreated.MethodsWe used a case-finding method to identify adults in the community with respiratory symptoms without diagnosed lung disease. Participants who were found to have undiagnosed COPD or asthma on spirometry were enrolled in a multicenter, randomized, controlled trial to determine whether early diagnosis and treatment reduces health care utilization for respiratory illness and improves health outcomes. Participants were assigned to receive the intervention (evaluation by a pulmonologist and an asthma–COPD educator who were instructed to initiate guideline-based care) or usual care by their primary care practitioner. The primary outcome was the annualized rate of participant-initiated health care utilization for respiratory illness. Secondary outcomes included changes from baseline to 1 year in disease-specific quality of life, as assessed with the St. George Respiratory Questionnaire (SGRQ; scores range from 0 to 100, with lower scores indicating better health status); symptom burden, as assessed with the COPD Assessment Test (CAT; scores range from 0 to 40, with lower scores indicating better health status); and forced expiratory volume in 1 second (FEV1).ResultsOf 38,353 persons interviewed, 595 were found to have undiagnosed COPD or asthma and 508 underwent randomization: 253 were assigned to the intervention group and 255 to the usual-care group. The annualized rate of a primary-outcome event was lower in the intervention group than in the usual-care group (0.53 vs. 1.12 events per person-year; incidence rate ratio, 0.48; 95% confidence interval [CI], 0.36 to 0.63; P<0.001). At 12 months, the SGRQ score was lower than the baseline score by 10.2 points in the intervention group and by 6.8 points in the usual-care group (difference, −3.5 points; 95% CI, −6.0 to −0.9), and the CAT score was lower than the baseline score by 3.8 points and 2.6 points, respectively (difference, −1.3 points; 95% CI, −2.4 to −0.1). The FEV1 increased by 119 ml in the intervention group and by 22 ml in the usual-care group (difference, 94 ml; 95% CI, 50 to 138). The incidence of adverse events was similar in the trial groups.ConclusionsIn this trial in which a strategy was used to identify adults in the community with undiagnosed asthma or COPD, those who received pulmonologist-directed treatment had less subsequent health care utilization for respiratory illness than those who received usual care. (Funded by Canadian Institutes of Health Research; UCAP ClinicalTrials.gov number, NCT03148210.)

Patterns of care in the management of high-risk COPD in the US (2011–2019): an observational study for the CONQUEST quality improvement program

In this study, we compare management of patients with high-risk chronic obstructive pulmonary disease (COPD) in the United States to national and international guidelines and quality standards, including the COllaboratioN on QUality improvement initiative for achieving Excellence in STandards of COPD care (CONQUEST). Patients were identified from the DARTNet Practice Performance Registry and categorized into three high-risk cohorts in each year from 2011 to 2019: newly diagnosed (≤12 months after diagnosis), already diagnosed, and patients with potential undiagnosed COPD. Patients were considered high-risk if they had a history of exacerbations or likely exacerbations (respiratory consult with prescribed medication). Descriptive statistics for 2019 are reported, along with annual trends. In 2019, 10% (n=16,610/167,197) of patients met high-risk criteria. Evidence of spirometry for diagnosis was low; in 2019, 81% (n=1228/1523) of patients newly diagnosed at high-risk had no record of spirometry/peak expiratory flow in the 12 months pre- or post-diagnosis and 43% (n=651/1523) had no record of COPD symptom review. Among those newly and already diagnosed at high-risk, 52% (n=4830/9350) had no evidence of COPD medication. Findings suggest inconsistent adherence to evidence-based guidelines, and opportunities to improve identification, documentation of services, assessment, therapeutic intervention, and follow-up of patients with COPD. This study was conducted by the Observational and Pragmatic Research Institute (OPRI) Pte Ltd and was partially funded by Optimum Patient Care Global and AstraZeneca Ltd. No funding was received by the Observational & Pragmatic Research Institute Pte Ltd (OPRI) for its contribution.

Association between COPD and Stage of Lung Cancer Diagnosis: A Population-Based Study.

Chronic obstructive pulmonary disease (COPD) is associated with an increased risk of lung cancer; however, the association between COPD and stage of lung cancer diagnosis is unclear. We conducted a population-based cross-sectional analysis of lung cancer patients (2008-2020) in Ontario, Canada. Using estimated propensity scores and inverse probability weighting, logistic regression models were developed to assess the association between COPD and lung cancer stage at diagnosis (early: I/II, advanced: III/IV), accounting for prior chest imaging. We further examined associations in subgroups with previously diagnosed and undiagnosed COPD. Over half (55%) of all lung cancer patients in Ontario had coexisting COPD (previously diagnosed: 45%, undiagnosed at time of cancer diagnosis: 10%). Compared to people without COPD, people with COPD had 30% lower odds of being diagnosed with lung cancer in the advanced stages (OR = 0.70, 95% CI: 0.68 to 0.72). Prior chest imaging only slightly attenuated this association (OR = 0.77, 95% CI: 0.75 to 0.80). The association with lower odds of advanced-stage diagnosis remained, regardless of whether COPD was previously diagnosed (OR = 0.68, 95% CI: 0.66 to 0.70) or undiagnosed (OR = 0.77, 95% CI: 0.73 to 0.82). Although most lung cancers are detected in the advanced stages, underlying COPD was associated with early-stage detection. Lung cancer diagnostics may benefit from enhanced partnership with COPD healthcare providers.

Current Progress of COPD Early Detection: Key Points and Novel Strategies.

Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality worldwide, with approximately 70% to 80% of adults with COPD being undiagnosed. Patients with undiagnosed COPD are at increased risk of poor outcomes and a worsened quality of life, making early detection a crucial strategy to mitigate the impact of COPD and reduce the burden on healthcare systems. In the past decade, increased interest has been focused on the development of effective strategies and instrument for COPD early detection. However, identifying undiagnosed cases of COPD is still challenging. Both screening and case-finding approaches have been adopted to identify undiagnosed COPD, with case-finding being recommended by the 2023 Global Initiative for Chronic Obstructive Lung Disease (GOLD) guideline and the updated United States Preventive Services Task Force (USPTF) recommendation. Nonetheless, the approaches, criteria, and instruments used for early detection of COPD are varied. However, advances in the taxonomy and risk factors of COPD are continuously being investigated. It is important to continuously assess the current state of knowledge on COPD early detection, given the challenges associated with identifying undiagnosed COPD. This review aims to highlight recent advances in early detection of COPD. To discuss the current challenge and opportunity in COPD early detection, providing an overview of existing literature on COPD case-finding strategies, including the approaches, criteria for subjects, and instruments. The review also summarizes the current progress in COPD case-findings and proposes a COPD case-finding flowchart as an efficient method for identifying at risk COPD patients.

Undiagnosed and ‘overdiagnosed’ COPD using postbronchodilator spirometry in primary healthcare settings: a systematic review and meta-analysis

BackgroundDespite chronic obstructive pulmonary disease (COPD) being a major global cause of mortality and hospitalisation, it is often undiagnosed or inaccurately diagnosed in clinical settings.ObjectiveTo systematically synthesise all peer-reviewed papers...

Development of a prediction model to identify undiagnosed chronic obstructive pulmonary disease patients in primary care settings in China.

At present, a large number of chronic obstructive pulmonary disease (COPD) patients are undiagnosed in China. Thus, this study aimed to develop a simple prediction model as a screening tool to identify patients at risk for COPD. The study was based on the data of 22,943 subjects aged 30 to 79 years and enrolled in the second resurvey of China Kadoorie Biobank during 2012 and 2013 in China. We stepwisely selected the predictors using logistic regression model. Then we tested the model validity through P-P graph, area under the receiver operating characteristic curve (AUROC), ten-fold cross validation and an external validation in a sample of 3492 individuals from the Enjoying Breathing Program in China. The final prediction model involved 14 independent variables, including age, sex, location (urban/rural), region, educational background, smoking status, smoking amount (pack-years), years of exposure to air pollution by cooking fuel, family history of COPD, history of tuberculosis, body mass index, shortness of breath, sputum and wheeze. The model showed an area under curve (AUC) of 0.72 (95% confidence interval [CI]: 0.72-0.73) for detecting undiagnosed COPD patients, with the cutoff of predicted probability of COPD=0.22, presenting a sensitivity of 70.13% and a specificity of 62.25%. The AUROC value for screening undiagnosed patients with clinically significant COPD was 0.68 (95% CI: 0.66-0.69). Moreover, the ten-fold cross validation reported an AUC of 0.72 (95% CI: 0.71-0.73), and the external validation presented an AUC of 0.69 (95% CI: 0.68-0.71). This prediction model can serve as a first-stage screening tool for undiagnosed COPD patients in primary care settings.

Diagnosis and treatment outcomes from prebronchodilator spirometry performed alongside lung cancer screening in a Lung Health Check programme

IntroductionIncorporating spirometry into low-dose CT (LDCT) screening for lung cancer may help identify people with undiagnosed chronic obstructive pulmonary disease (COPD), although the downstream impacts are not well described.MethodsParticipants attending...

Prevalence of abnormal spirometry in individuals with a smoking history and no known obstructive lung disease

IntroductionRecent evidence suggests a high prevalence of undiagnosed chronic obstructive pulmonary disease (COPD). These individuals are at risk of exacerbations and delayed treatment. We analyzed an at-risk population for the prevalence of abnormal spirometry to provide clarity into who should undergo early spirometry. MethodsWe analyzed data from the COPDGene study. Participants with ≥10 pack-years of smoking were included. Individuals with self-reported or physician-diagnosed COPD, asthma, chronic bronchitis, emphysema and/or were on inhalers were excluded. Parsimonious multivariable logistic regression models identified factors associated with abnormal spirometry, defined as either airflow obstruction (AFO) or preserved ratio impaired spirometry. Variables were selected for the final model using a stepwise backward variable elimination process which minimized Akaike information criterion (AIC). Similarly, during the 5-year follow-up period, we assessed factors associated with incident diagnosis of COPD. ResultsOf 5055 individuals, 1064 (21%) had undiagnosed AFO. Age, pack-years, current smoking and a history of acute bronchitis were associated with AFO while body mass index, female sex, and Black race were inversely associated. Among 2800 participants with 5-year follow-up, 532 (19%) had an incident diagnosis of COPD. Associated risk factors included mMRC ≥2, chronic productive cough, respiratory exacerbations during the follow-up period, and abnormal spirometry. Age was inversely associated. ConclusionsThe prevalence of undiagnosed COPD is high in at-risk populations. We found multiple factors associated with undiagnosed COPD and incident diagnosis of COPD at follow up. These results can be used to identify those at risk for undiagnosed COPD to facilitate earlier diagnosis and treatment.

PROMETHEUS: Long-Term Exacerbation and Mortality Benefits of Implementing Single-Inhaler Triple Therapy in the US COPD Population.

Background: The US population includes 24 million to 29 million people with diagnosed and undiagnosed chronic obstructive pulmonary disease (COPD). Studies have demonstrated the safety and efficacy of single-inhaler triple therapy (SITT) in reducing COPD exacerbations. Long-term population implications of SITT use have not been quantified. Objectives: This simulation-based projection aimed to estimate the potential impact of widespread SITT use on the US COPD population. Methods: Exacerbation and all-cause mortality reductions reported in the Efficacy and Safety of Triple Therapy in Obstructive Lung Disease trial (ETHOS; NCT02465567) were used to project clinical outcomes in US patients meeting ETHOS trial eligibility criteria (ETHOS-Eligible) and patients meeting a practical definition of SITT eligibility (Expanded ETHOS-Eligible). The US COPD population was modeled with 1000 simulations of patient progression over 10 years. Agent characteristics were based on literature and claims analysis of the 2016-2018 Medicare 100% fee-for-service and IBM MarketScan® databases. Agent annual characteristics reflected incident cases, changes in COPD severity, treatment, mortality, and exacerbations under status quo treatment patterns and scenarios for the adoption of SITT. The scenarios assumed the reduced exacerbation and mortality rates associated with SITT according to ETHOS trial outcomes mean values. Results: Higher than current SITT adoption over 10 years would be expected to substantially reduce COPD exacerbation-associated hospitalizations by 2 million. Applying mean improvements reported in ETHOS for SITT would extend average patient life expectancy 2.2 years for ETHOS-Eligible patients and 1.7 years for Expanded ETHOS-Eligible patients. The number needed to treat to extend the average patient life by 1 year was 8 for the ETHOS-Eligible population and 10 for the Expanded ETHOS-Eligible population. Discussion: Widespread SITT adoption may be impeded by competitive pressures from generic treatments and nonadherence, and efficacy observed in clinical trials may not occur in real-world populations. Conclusions: Assuming ETHOS treatment effects and adherence translate to clinical practice, higher than current use of SITT can substantially reduce COPD exacerbations and hospitalizations and extend survival. These results should be viewed cautiously, because the improved outcomes for SITT in the ETHOS final retrieved vital statistics data were not statistically significant for all comparator therapy groups.

PROMETHEUS: Long-Term Exacerbation and Mortality Benefits of Implementing Single-Inhaler Triple Therapy in the US COPD Population

Background: The US population includes 24 million to 29 million people with diagnosed and undiagnosed chronic obstructive pulmonary disease (COPD). Studies have demonstrated the safety and efficacy of single-inhaler triple therapy (SITT) in reducing COPD exacerbations. Long-term population implications of SITT use have not been quantified. Objectives: This simulation-based projection aimed to estimate the potential impact of widespread SITT use on the US COPD population. Methods: Exacerbation and all-cause mortality reductions reported in the Efficacy and Safety of Triple Therapy in Obstructive Lung Disease trial (ETHOS; NCT02465567) were used to project clinical outcomes in US patients meeting ETHOS trial eligibility criteria (ETHOS-Eligible) and patients meeting a practical definition of SITT eligibility (Expanded ETHOS-Eligible). The US COPD population was modeled with 1000 simulations of patient progression over 10 years. Agent characteristics were based on literature and claims analysis of the 2016-2018 Medicare 100% fee-for-service and IBM MarketScan® databases. Agent annual characteristics reflected incident cases, changes in COPD severity, treatment, mortality, and exacerbations under status quo treatment patterns and scenarios for the adoption of SITT. The scenarios assumed the reduced exacerbation and mortality rates associated with SITT according to ETHOS trial outcomes mean values. Results: Higher than current SITT adoption over 10 years would be expected to substantially reduce COPD exacerbation-associated hospitalizations by 2 million. Applying mean improvements reported in ETHOS for SITT would extend average patient life expectancy 2.2 years for ETHOS-Eligible patients and 1.7 years for Expanded ETHOS-Eligible patients. The number needed to treat to extend the average patient life by 1 year was 8 for the ETHOS-Eligible population and 10 for the Expanded ETHOS-Eligible population. Discussion: Widespread SITT adoption may be impeded by competitive pressures from generic treatments and nonadherence, and efficacy observed in clinical trials may not occur in real-world populations. Conclusions: Assuming ETHOS treatment effects and adherence translate to clinical practice, higher than current use of SITT can substantially reduce COPD exacerbations and hospitalizations and extend survival. These results should be viewed cautiously, because the improved outcomes for SITT in the ETHOS final retrieved vital statistics data were not statistically significant for all comparator therapy groups.

Capturing the missing millions with COPD

It is estimated that there may be as many as 2 million people in the UK who have undiagnosed chronic obstructive pulmonary disease (COPD). Undiagnosed COPD results in an increased symptom burden, reduced quality of life, risk of exacerbations and the potential to develop comorbid conditions. General practice nurses have a key role to play in identifying those who may have COPD and ensuring patients get timely treatment to reduce unnecessary suffering and risk to health.

Comparison of Frequency of Undiagnosed Chronic Obstructive Pulmonary Disease in Current or Former Tobacco Smokers Having Ischaemic Heart Disease

This study compares the frequency of undiagnosed chronic obstructive pulmonary disease (COPD) in tobacco smokers suffering from ischaemic heart disease (IHD) and analyses the association of COPD severity with status, type and duration of smoking. An analytical cross-sectional study conducted in current and former cigarette, hookah and combined cigarette and hookah smokers with IHD to detect previously undiagnosed COPD through spirometry. Among 124 males with IHD, majority [74 (59.7%)] were former smokers and were in the age ranged between 42 to 78 years. All had dyspnoea up to grade 4 and 64 (51.6%) also reported chronic cough and sputum production. According to type of smoking, 64 (51.6%) smoked cigarettes, 30 (24.2%) smoked hookah and 30 (24.2%) smoked both hookah and cigarettes. Forty-seven (37.9%) were found to have COPD, 24 (37.5%) among cigarette smokers, 12 (40%) among hookah smokers, while 11 (36.7%) were from cigarette and hookah smokers. Duration of smoking, its type and magnitude had no association with severity of COPD. The frequency of undiagnosed COPD is high in smokers with IHD. Hookah and combined hookah and cigarette smokers are almost as susceptible to develop COPD as are cigarette smokers.

Potential clinical implications of targeted spirometry for detection of COPD: A contemporary population-based cohort study

BackgroundEarly diagnosis of chronic obstructive pulmonary disease (COPD) through targeted spirometry may provide better treatment opportunities and in the long run reduce its high burden. We therefore investigated potential beneficial clinical implications of targeted spirometry for detection of COPD and focus on both pulmonary and extrapulmonary conditions in a contemporary general population cohort. MethodsWe recruited 29 678 randomly selected adults from the Copenhagen General Population Study from 2014 to 2017. Individuals unlikely to have undiagnosed COPD with a treatment potential were excluded (age <40 or >80, no smoking or respiratory symptoms, previous COPD/asthma diagnosis). COPD was defined as pre-bronchodilator forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC) <0.70 and FEV1 <80% of predicted. Results5520 (19%) were at high risk of undiagnosed COPD, of whom 589 (11%) fulfilled our COPD criteria. Of these, 45% were smokers, 23% reported modified Medical Research Council dyspnoea scale (mMRC) ≥2, 49% reported COPD assessment test (CAT) ≥10, and 12% reported low physical activity. In addition, 8% were underweight, 28% were obese, 28% had undiagnosed hypertension, 49% had undiagnosed hypercholesterolemia, and 1% had undiagnosed diabetes. When all treatable conditions were considered, only 6.5% of individuals with undiagnosed COPD had no potentially treatable condition, while 73% had at least two treatable conditions. ConclusionsIn a general population setting, one undiagnosed COPD case will be detected for every tenth spirometry in smokers with respiratory symptoms. Up to half of individuals with undiagnosed COPD could potentially benefit from smoking cessation, treatment of respiratory symptoms, increased physical activity, and treatment of other undiagnosed comorbidities. LimitationPost-bronchodilator spirometry was not used to diagnose COPD.

Undiagnosed Chronic Obstructive Pulmonary Disease is Highly Prevalent in Patients Referred for Dobutamine Stress Echocardiography with Shortness of Breath.

Shortness of breath (SOB) is a common symptom referral for dobutamine stress echocardiography (DSE). Patients with SOB and a normal DSE have worse long-term outcome than the general population. This suggests multiple aetiologies are involved. The purpose of this study was to assess the prevalence and clinical significance of undiagnosed COPD amongst patients referred for a DSE with SOB. We prospectively studied 114 patients referred for DSE with SOB without prior evidence of lung disease (mean age 64.9 ± 18.5years, 60 male). Respiratory function testing using spirometry was performed on all patients on the day of their DSE. The study end-points were cardiac events and total mortality. Respiratory function testing and DSE was performed in all patients and COPD was highly prevalent (n = 93). Multivariate Cox regression analysis was used to estimate the effect of dyspnoea on non-fatal cardiac events (NFCE) and all-cause mortality. Over a mean follow-up of 4.5 ± 2.6years, the composite end-point of NFCE and all-cause mortality occurred in 62.7% and 16.7% patients, respectively. COPD (HR 1.27; 95% CI 1.17-1.93), previous myocardial infarction (HR 1.84; 95% CI 1.06-3.2), myocardial ischaemia (HR 2.56; 95% CI 1.48-4.43), peak wall motion score index (HR 4.66; 95% CI 2.26-9.6), and mitral E/E' (HR 1.21; 95% CI 1.1-1.33) were significantly associated with a NFCE. Myocardial ischaemia (HR 4.43; 95% CI 1.24-15.81) was the only independent predictor of all-cause mortality. Undiagnosed COPD is highly prevalent and independently associated with worse outcome amongst patients with SOB referred for DSE. Symptom presentation is therefore an important consideration when interpreting DSE results.

Case-finding and improving patient outcomes for chronic obstructive pulmonary disease in primary care: the BLISS research programme including cluster RCT

Case-finding and improving patient outcomes for chronic obstructive pulmonary disease in primary care: the BLISS research programme including cluster RCT

Accuracy and cost-effectiveness of different screening strategies for identifying undiagnosed COPD among primary care patients (≥40 years) in China: a cross-sectional screening test accuracy study: findings from the Breathe Well group

ObjectivesTo examine the accuracy and cost-effectiveness of various chronic obstructive pulmonary disease (COPD) screening tests and combinations within a Chinese primary care population.DesignScreening test accuracy study.SettingUrban and rural community health...