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Original Research: COPD |

Do Symptoms Predict COPD in Smokers?

Jill A. Ohar, MD, FCCP; Alireza Sadeghnejad, MD, PhD; Deborah A. Meyers, PhD; James F. Donohue, MD, FCCP; Eugene R. Bleecker, MD, FCCP
Author and Funding Information

From the Section of Pulmonary, Critical Care, Allergy and Immunologic Diseases (Dr Ohar) and Center for Genomics and Personalized Medicine Research (Drs Sadeghnejad, Meyers, and Bleecker), Wake Forest University School of Medicine, Winston-Salem, NC; and Division of Pulmonary Disease (Dr Donohue), University of North Carolina School of Medicine, Chapel Hill, NC.

Correspondence to: Jill A. Ohar, MD, FCCP, Wake Forest University School of Medicine, Medical Center Blvd, Winston-Salem, NC 27157; e-mail: johar@wfubmc.edu


Funding/Support: The creation of the database was funded in part by the Selikoff Fund at Saint Louis University. Data analysis was funded in part by Spiromics Clinical Center [NIH HHSN 268200900019C].

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestpubs.org/site/misc/reprints.xhtml).


© 2010 American College of Chest Physicians


Chest. 2010;137(6):1345-1353. doi:10.1378/chest.09-2681
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Background:  The US Preventive Services Task Force recommends against spirometry in the absence of symptoms. However, as much as 50% of COPD cases in the United States remain undiagnosed.

Methods:  Report of symptoms, smoking history, and spirometric data were collected from subjects screened for a work-related medical evaluation (N = 3,955). Prevalence of airflow obstruction and respiratory symptoms were assessed. Sensitivity, specificity, positive and negative predictive values, and relative risks of predicting symptoms and smoking history for COPD were calculated.

Results:  Forty-four percent of smokers in our sample had airways obstruction (AO). Of these, 36% reported a diagnosis of or treatment for COPD. Odds ratio (95% CI) for AO with smoking (≥ 20 pack-years) was 3.73 (3.12- 4.45), 1.98 (1.73-2.27) for cough, 1.79 (1.55-2.08) for dyspnea, 1.95 (1.70-2.34) for sputum, and 2.59 (2.26-2.97) for wheeze. Respiratory symptoms were reported by 92% of smokers with AO, 86% smokers with restriction, 76% smokers with normal spirometry, and 73% of nonsmokers. Sensitivity (92% vs 90%), specificity (19% vs 22%), positive (47% vs 40%) and negative (75% vs 80%) predictive values for the presence of one or more symptoms were similar between smokers and all subjects.

Conclusions:  COPD is underdiagnosed in the United States. Symptoms are frequent in subjects with AO and increase their risk for COPD, but add little beyond age and smoking history to the predictive value of spirometry. In view of the high prevalence of symptoms and their poor predictive value, a simpler and more effective approach would be to screen older smokers.

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