title: Using targeted spirometry to reduce non-diagnosed chronic obstructive pulmonary disease.
abstract: BACKGROUND
  Chronic obstructive pulmonary disease (COPD) is increasing worldwide and thus its associated morbidity and mortality. However, COPD often goes undiagnosed.
  
  
  OBJECTIVE
  We evaluated the rate of non-diagnosed irreversible airway obstruction (AO) and characterized this patient group. We further assessed the possible effects of conducting targeted spirometry in a population sample in Salzburg, Austria, as part of the Burden of Obstructive Lung Disease (BOLD) study.
  
  
  METHODS
  1,258 adults ≥40 years of age completed a questionnaire and performed spirometry before and after bronchodilator therapy (post-BD). Irreversible AO was defined as post-BD FEV(1)/FVC below the lower limit of normal; we used the FEV(1)% predicted (pred.) to further grade the disease. Participants without a physician diagnosis of COPD who reported respiratory symptoms and a history of risk factors (ever smoking or occupational risk) were defined as eligible for targeted spirometry.
  
  
  RESULTS
  85.9% (171/199) of the participants with irreversible AO did not report a prior diagnosis of COPD. Non-diagnosed AO was inversely related to severity, age, self-reported prior respiratory diseases and cough as a respiratory symptom. 343 participants were eligible for targeted spirometry and irreversible AO was present in 86 (25.1%) participants. Therefore, targeted spirometry could reduce the underdiagnosis of irreversible AO of any severity by 50.3% (86 of 171). The diagnosis of 1 person with FEV(1) <80% pred. would require spirometry in 8.4 subjects (95% confidence interval 6.2-11.1).
  
  
  CONCLUSIONS
  Although several factors are associated with non-diagnosed AO, spirometry in individuals with respiratory symptoms and exposure to risk factors could reduce undiagnosed irreversible AO by half.
authors: Department of Pulmonary Medicine, Paracelsus Medical University Hospital, Salzburg, Austria. l.schirnhofer @ salk.at
authors: Lea
authors: L
authors: Schirnhofer
authors: Bernd
authors: B
authors: Lamprecht
authors: Natalie
authors: N
authors: Firlei
authors: Bernhard
authors: B
authors: Kaiser
authors: A Sonia
authors: AS
authors: Buist
authors: Ronald J
authors: RJ
authors: Halbert
authors: Michael J
authors: MJ
authors: Allison
authors: Michael
authors: M
authors: Studnicka
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis*; D013147:Spirometry