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© 2024 Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. http://creativecommons.org/licenses/by-nc/4.0/ This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:  http://creativecommons.org/licenses/by-nc/4.0/ . Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.

Abstract

Background

Studies suggest that up to 70% of chronic obstructive pulmonary disease (COPD) cases globally are undiagnosed worldwide. Some of these undiagnosed patients may present with severe exacerbation and factors associated with underdiagnosis in this population are unknown. We investigated the key factors associated with underdiagnosis in two cohorts of patients hospitalised for severe COPD exacerbation at different time points.

Methods

This retrospective, multicentre study analysed data from patients hospitalised for COPD exacerbation at two independent centres during two distinct time periods: between 1 January 2017 and 31 December 2018 in the Aquitaine region and between 1 January and 31 December 2022 in Paris. Undiagnosed COPD was defined as the absence of pulmonary function testing before the index exacerbation. Multivariate logistic regression was used to evaluate associations between underdiagnosis and patient characteristics.

Results

Among the 424 patients, 93 (21.9%) were undiagnosed before hospitalisation, with a stable rate over time (22% in 2017–2018 and 21% in 2022). Multivariate analysis revealed that underdiagnosis was related to higher forced expiratory volume in one second (FEV1; adjusted OR (aOR)=1.02, p=0.043) and female sex (aOR=1.91, p=0.015). Patients with undiagnosed COPD had significantly lower rehospitalisation and mortality rates. After the initial severe exacerbation, higher mortality was associated with a higher Charlson Comorbidity Index (HR=1.24, p=0.007) and older age (HR=1.05, p=0.008).

Conclusion

This retrospective, multicentre study demonstrated that about 20% of patients admitted with severe exacerbation were undiagnosed for COPD. Higher FEV1 and female sex were associated with underdiagnosis, emphasising the need for special attention to this population. These findings highlight the need to improve training and access to spirometry and develop new diagnostic tools that facilitate earlier detection and management of COPD.

Details

Title
Factors associated with undiagnosed COPD in patients hospitalised for severe COPD exacerbation
Author
Guecamburu, Marina 1   VIAFID ORCID Logo  ; Klein, Emilie 2 ; Verdy, Guillaume 3 ; Nocent-Ejnaini, Cécilia 4 ; Macey, Julie 2 ; Portel, Laurent 5 ; Grassion, Léo 2   VIAFID ORCID Logo  ; Soumagne, Thibaud 6 ; Zysman, Maéva 7   VIAFID ORCID Logo 

 Service des Maladies Respiratoires, Hôpital Haut Lévèque, CHU de Bordeaux, Pessac, France; Centre Hospitalier de la Côte Basque, Bayonne, France; Centre Hospitalier Robert Boulin, Libourne, France 
 Service des Maladies Respiratoires, Hôpital Haut Lévèque, CHU de Bordeaux, Pessac, France 
 Service d’Information Médicale, Pessac, France 
 Centre Hospitalier de la Côte Basque, Bayonne, France 
 Centre Hospitalier Robert Boulin, Libourne, France 
 Service de Pneumologie et de Soins Intensifs Respiratoires, Hôpital Européen Georges Pompidou, APHP Centre, Paris, France 
 Service des Maladies Respiratoires, Hôpital Haut Lévèque, CHU de Bordeaux, Pessac, France; Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, CIC 1401, Université de Bordeaux, Pessac, France 
First page
e002620
Section
Chronic obstructive pulmonary disease
Publication year
2024
Publication date
2024
Publisher
BMJ Publishing Group LTD
e-ISSN
20524439
Source type
Scholarly Journal
Language of publication
English
ProQuest document ID
3152616624
Copyright
© 2024 Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. http://creativecommons.org/licenses/by-nc/4.0/ This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:  http://creativecommons.org/licenses/by-nc/4.0/ . Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.