Bernd Lamprecht1, Joan B Soriano2, Michael Studnicka3, Bernhard Kaiser4, Lowie E Vanfleteren5, Louisa Gnatiuc6, Peter Burney6, Marc Miravitlles7, Francisco García-Rio8, Kaveh Akbari9, Julio Ancochea10, Ana M Menezes11, Rogelio Perez-Padilla12, Maria Montes de Oca13, Carlos A Torres-Duque14, Andres Caballero15, Mauricio González-García16, Sonia Buist17. 1. Department of Pulmonary Medicine, Kepler University Hospital, Linz, Austria; Faculty of Medicine, Johannes-Kepler-University, Linz, Austria. Electronic address: bernd.lamprecht@akh.linz.at. 2. Instituto de Investigación, Hospital Universitario de la Princesa (IISP), Universidad Autónoma de Madrid, Catédra UAM-Linde, Madrid, Spain. 3. Department of Pulmonary Medicine, Paracelsus Medical University, Salzburg, Austria. 4. Faculty of Medicine, Johannes-Kepler-University, Linz, Austria. 5. Department of Respiratory Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands; Program Development Centre, CIRO+, Centre of Expertise for Chronic Organ Failure, Horn, The Netherlands. 6. Respiratory Epidemiology and Public Health, Imperial College, London, England. 7. Servicio de Neumología, Hospital Universitari Vall d'Hebron, Ciber de Enfermedades Respiratorias (CIBERES), Barcelona, Spain. 8. Servicio de Neumología, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain. 9. Department of Radiology, General Hospital Linz (Akh Linz), Linz, Austria. 10. Servicio de Neumología, Hospital La Princesa, Universidad Autónoma de Madrid, Madrid, Spain. 11. Programa de Pós-Graduacão em Epidemiologia, Universidade Federal de Pelotas, Pelotas, Brazil. 12. Institute of Respiratory Diseases, Instituto Nacional de Enfermedades Respiratorias, Mexico City, Mexico. 13. Servicio de Neumonología, Hospital Universitario de Caracas, Facultad de Medicina, Universidad Central de Venezuela, Caracas, Venezuela. 14. Departamento de Investigación, Fundación Neumológica Colombiana, Bogotá, Colombia; Asociación Colombiana de Neumología y Cirugía de Tórax, Bogotá, Colombia. 15. Asociación Colombiana de Neumología y Cirugía de Tórax, Bogotá, Colombia; Clínica Reina Sofía, Bogotá, Colombia. 16. Departamento de Investigación, Fundación Neumológica Colombiana, Bogotá, Colombia. 17. Oregon Health & Science University, Portland, OR.
Abstract
BACKGROUND: COPD ranks within the top three causes of mortality in the global burden of disease, yet it remains largely underdiagnosed. We assessed the underdiagnosis of COPD and its determinants in national and international surveys of general populations. METHODS: We analyzed representative samples of adults aged ≥ 40 years randomly selected from well-defined administrative areas worldwide (44 sites from 27 countries). Postbronchodilator FEV1/FVC < lower limit of normal (LLN) was used to define chronic airflow limitation consistent with COPD. Undiagnosed COPD was considered when participants had postbronchodilator FEV1/FVC < LLN but were not given a diagnosis of COPD. RESULTS: Among 30,874 participants with a mean age of 56 years, 55.8% were women, and 22.9% were current smokers. Population prevalence of (spirometrically defined) COPD ranged from 3.6% in Barranquilla, Colombia, to 19.0% in Cape Town, South Africa. Only 26.4% reported a previous lung function test, and only 5.0% reported a previous diagnosis of COPD, whereas 9.7% had a postbronchodilator FEV1/FVC < LLN. Overall, 81.4% of (spirometrically defined) COPD cases were undiagnosed, with the highest rate in Ile-Ife, Nigeria (98.3%) and the lowest rate in Lexington, Kentucky (50.0%). In multivariate analysis, a greater probability of underdiagnosis of COPD was associated with male sex, younger age, never and current smoking, lower education, no previous spirometry, and less severe airflow limitation. CONCLUSIONS: Even with substantial heterogeneity in COPD prevalence, COPD underdiagnosis is universally high. Because effective management strategies are available for COPD, spirometry can help in the diagnosis of COPD at a stage when treatment will lead to better outcomes and improved quality of life.
BACKGROUND:COPD ranks within the top three causes of mortality in the global burden of disease, yet it remains largely underdiagnosed. We assessed the underdiagnosis of COPD and its determinants in national and international surveys of general populations. METHODS: We analyzed representative samples of adults aged ≥ 40 years randomly selected from well-defined administrative areas worldwide (44 sites from 27 countries). Postbronchodilator FEV1/FVC < lower limit of normal (LLN) was used to define chronic airflow limitation consistent with COPD. Undiagnosed COPD was considered when participants had postbronchodilator FEV1/FVC < LLN but were not given a diagnosis of COPD. RESULTS: Among 30,874 participants with a mean age of 56 years, 55.8% were women, and 22.9% were current smokers. Population prevalence of (spirometrically defined) COPD ranged from 3.6% in Barranquilla, Colombia, to 19.0% in Cape Town, South Africa. Only 26.4% reported a previous lung function test, and only 5.0% reported a previous diagnosis of COPD, whereas 9.7% had a postbronchodilator FEV1/FVC < LLN. Overall, 81.4% of (spirometrically defined) COPD cases were undiagnosed, with the highest rate in Ile-Ife, Nigeria (98.3%) and the lowest rate in Lexington, Kentucky (50.0%). In multivariate analysis, a greater probability of underdiagnosis of COPD was associated with male sex, younger age, never and current smoking, lower education, no previous spirometry, and less severe airflow limitation. CONCLUSIONS: Even with substantial heterogeneity in COPD prevalence, COPD underdiagnosis is universally high. Because effective management strategies are available for COPD, spirometry can help in the diagnosis of COPD at a stage when treatment will lead to better outcomes and improved quality of life.
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