PHILADELPHIA — Patients with a history of smoking and symptoms of chronic bronchitis had a 26% prevalence of airflow obstruction consistent with chronic obstructive pulmonary disease, in a cross-sectional study of more than 1,200 people seen at primary care centers.
“Spirometry should be considered in anyone with a smoking history and respiratory symptoms,” Dr. Barbara P. Yawn and her associates said in a poster presented at the annual meeting of the American College of Chest Physicians. The finding highlights that physicians “should be vigilant to the potential for airflow obstruction in patients with symptoms of chronic bronchitis,” the researchers wrote. “Despite the increasing incidence of COPD worldwide, the vast majority of patients with the disease remain undiagnosed and underreported,” they added.
“Understanding the patients who are at greatest risk for having undiagnosed COPD should help improve disease recognition, diagnosis, and management,” Dr. Yawn said in a written statement. Increasing the targeted use of spirometry “will improve recognition of COPD,” added Dr. Yawn, a family medicine physician and director of research at Olmsted Medical Center in Rochester, Minn.
The prevalence of airflow obstruction consistent with COPD was determined in people aged 40 years or older who were patients at any of 40 U.S. primary care centers. Eligible participants had symptoms of chronic bronchitis and a smoking history of at least 10 pack-years. These participants were assessed using spirometry and two questionnaires: the 12-item Short Form Health Survey, a modified respiratory questionnaire from the American Thoracic Society, and the Lung Function Questionnaire.
The average age of the 1,283 participants was 53 years (range 40–87 years), and 55% were women. Most were white (81%), and 17% were African American. Their average body mass index was almost 29 kg/m
Airflow obstruction indicative of COPD, defined as forced expiratory volume in 1 second divided by forced vital capacity (FEV1/FVC) of 70% or less following bronchodilator (albuterol) treatment, occurred in 26% of the patients. The prevalence of undiagnosed obstructive lung disease—defined as an FEV1/FVC of 70% or less before bronchodilator treatment—was 34%. Bronchodilator reversibility was absent in 91% of participants. Slight dyspnea impairment, defined as shortness of breath when hurrying on level ground or when walking up a slight hill, existed in 47%. Coughing four to six times a day at least 4 days per week was reported by 79%, and 75% reported a whistling sound in their chests.
The analysis also showed that the prevalence of a breathing impairment suggestive of COPD increased with age. The study was funded by GlaxoSmithKline, and one of Dr. Yawn's associates was a GSK employee. Dr. Yawn and her other associates said that they had no conflicts of interest to disclose.
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