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Original Research: COPD |

Determinants of Underdiagnosis of COPD in National and International SurveysUnderdiagnosis of COPD

Bernd Lamprecht, MD; Joan B. Soriano, MD, FCCP; Michael Studnicka, MD, FCCP; Bernhard Kaiser, MSc; Lowie E. Vanfleteren, MD, PhD; Louisa Gnatiuc, MSc; Peter Burney, MD; Marc Miravitlles, MD; Francisco García-Rio, MD; Kaveh Akbari, MD; Julio Ancochea, MD; Ana M. Menezes, MD; Rogelio Perez-Padilla, MD; Maria Montes de Oca, MD; Carlos A. Torres-Duque, MD; Andres Caballero, MD; Mauricio González-García, MD; Sonia Buist, MD; for the BOLD Collaborative Research Group, the EPI-SCAN Team, the PLATINO Team, and the PREPOCOL Study Group
Author and Funding Information

From the Department of Pulmonary Medicine (Dr Lamprecht), Kepler University Hospital, Linz, Austria; Faculty of Medicine (Dr Lamprecht and Mr Kaiser), Johannes-Kepler-University, Linz, Austria; Instituto de Investigación (Dr Soriano), Hospital Universitario de la Princesa (IISP), Universidad Autónoma de Madrid, Catédra UAM-Linde, Madrid, Spain; Department of Pulmonary Medicine (Dr Studnicka), Paracelsus Medical University, Salzburg, Austria; Department of Respiratory Medicine (Dr Vanfleteren), Maastricht University Medical Centre, Maastricht, The Netherlands; Program Development Centre (Dr Vanfleteren), CIRO+, Centre of Expertise for Chronic Organ Failure, Horn, The Netherlands; Respiratory Epidemiology and Public Health (Ms Gnatiuc and Dr Burney), Imperial College, London, England; Servicio de Neumología (Dr Miravitlles), Hospital Universitari Vall d’Hebron, Ciber de Enfermedades Respiratorias (CIBERES), Barcelona, Spain; Servicio de Neumología (Dr García-Rio), Hospital Universitario La Paz, IdiPAZ, Madrid, Spain; Department of Radiology (Dr Akbari), General Hospital Linz (Akh Linz), Linz, Austria; Servicio de Neumología (Dr Ancochea), Hospital La Princesa, Universidad Autónoma de Madrid, Madrid, Spain; Programa de Pós-Graduacão em Epidemiologia (Dr Menezes), Universidade Federal de Pelotas, Pelotas, Brazil; Institute of Respiratory Diseases (Dr Perez-Padilla), Instituto Nacional de Enfermedades Respiratorias, Mexico City, Mexico; Servicio de Neumonología (Dr Montes de Oca), Hospital Universitario de Caracas, Facultad de Medicina, Universidad Central de Venezuela, Caracas, Venezuela; Departamento de Investigación (Drs Torres-Duque and González-García), Fundación Neumológica Colombiana, Bogotá, Colombia; Asociación Colombiana de Neumología y Cirugía de Tórax (Drs Torres-Duque and Caballero), Bogotá, Colombia; Clínica Reina Sofía (Dr Caballero), Bogotá, Colombia; and Oregon Health & Science University (Dr Buist), Portland, OR.

CORRESPONDENCE TO: Bernd Lamprecht, MD, Faculty of Medicine, Johannes-Kepler-University, Krankenhausstraße 9, 4020 Linz, Austria; e-mail: bernd.lamprecht@akh.linz.at


FUNDING/SUPPORT: The initial Burden of Obstructive Lung Disease (BOLD) program was funded in part by unrestricted educational grants to the coordinating center in Portland, Oregon, from Aventis, AstraZeneca, Boehringer Ingelheim GmbH, Chiesi Farmaceutici SpA, GlaxoSmithKline plc, Merck Sharp & Dohme Corp, Novartis AG, Pfizer Inc, Schering-Plough, Sepracor Inc, and the University of Kentucky. The BOLD study is currently funded by a grant from The Wellcome Trust [085790/Z/08/Z], which supports the London, England, coordinating center. The Latin American Project for the Investigation of Obstructive Lung Disease (PLATINO) was funded by Boehringer Ingelheim GmbH. The Epidemiologic Study of COPD in Spain (EPI-SCAN) study was funded by an unrestricted grant from GlaxoSmithKline Spain. The Prevalence Study of COPD in Colombia (PREPOCOL) was sponsored by an educational contribution from the Colombian offices of Boehringer Ingelheim GmbH and Pfizer Inc (Bogotá, Colombia). Support for the present work was provided by European Respiratory Society Fellowship STRTF 326-2011.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2015;148(4):971-985. doi:10.1378/chest.14-2535
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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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