Journal
INTERNATIONAL JOURNAL OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE
Volume 12, Issue -, Pages 1269-1277Publisher
DOVE MEDICAL PRESS LTD
DOI: 10.2147/COPD.S127923
Keywords
epidemiology; spirometry; chronic airflow obstructions; mortality
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Funding
- Swedish Heart-Lung Foundation
- Norrbotten County Council
- Visare Norr
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Introduction: According to guidelines, the diagnosis of COPD should be confirmed by post-bronchodilator (post-BD) airway obstruction on spirometry; however, in clinical practice, this is not always performed. The aim of this population-based study was to compare clinical characteristics and prognosis, assessed as mortality, between subjects with airway obstruction divided into pre-but not post-BD obstruction, post-BD airway obstruction (COPD), and subjects without airway obstruction. Materials and methods: In 2002-2004, four adult population-based cohorts were reexamined with spirometry and structured interview. Subjects with airway obstruction, with a ratio of forced expiratory volume in 1 s to (forced) vital capacity,0.70 (n=993), were identified together with sex-and age-matched referents (n=993). These subjects were further divided into subjects with pre-but not post-BD airway obstruction (pre-not post-BD obstruction) and subjects with post-BD airway obstruction (COPD). Mortality data were collected until December 31, 2014. Results: Out of 993 subjects with airway obstruction, 736 (74%) had COPD and 257 (26%) pre-not post-BD obstruction. Any respiratory symptoms, allergic rhinitis, asthma, exacerbations, and comorbidities were equally common among subjects with COPD and pre-not post-BD obstruction, but less common among nonobstructive subjects. Mortality was highest among subjects with COPD and higher in men than in women. In both sexes, COPD, but not pre-not post-BD obstruction, was associated with an increased risk for death compared to those without airway obstruction. When COPD was divided into Global Initiative for Chronic Obstructive Lung Disease (GOLD) stages, GOLD 2 and 3-4 had an increased risk for death when compared to the nonobstructive group, also when adjusted for common confounders and comorbidities such as heart disease, diabetes, and anxiety/depression. Conclusion: Even though subjects with COPD and pre-not post-BD obstruction had fairly similar presentation of clinical characteristics, only those with COPD, specifically GOLD stage >= 2, had increased risk for death when compared with nonobstructive subjects.
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