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01.12.2015 | Research article | Ausgabe 1/2015 Open Access

BMC Pulmonary Medicine 1/2015

Characterisation and prognosis of undiagnosed chronic obstructive pulmonary disease patients at their first hospitalisation

Zeitschrift:
BMC Pulmonary Medicine > Ausgabe 1/2015
Autoren:
Eva Balcells, Elena Gimeno-Santos, Jordi de Batlle, Maria Antonia Ramon, Esther Rodríguez, Marta Benet, Eva Farrero, Antoni Ferrer, Stefano Guerra, Jaume Ferrer, Jaume Sauleda, Joan A Barberà, Àlvar Agustí, Robert Rodriguez-Roisin, Joaquim Gea, Josep M Antó, Judith Garcia-Aymerich, the PAC-COPD Study Group
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1186/​1471-2466-15-4) contains supplementary material, which is available to authorized users.

Competing interests

Jaume Ferrer has received payments from Novartis, Menarini, Boehringer and Astra-Zeneca for congress assistance, scientific talks and expert meetings.

Authors’ contributions

All authors have contributed to (i) the conception and design of the study; (ii) analysis and interpretation of data; and (iii) writing the article or revising it critically for important intellectual content. EB and JG-A performed the statistical analysis and interpreted the results. EB prepared the first draft of the paper. EB and JG-A had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. All authors read and approved the final manuscript.

Abstract

Background

Under-diagnosis of COPD is an important unmet medical need. We investigated the characteristics and prognosis of hospitalised patients with undiagnosed COPD.

Methods

The PAC-COPD cohort included 342 COPD patients hospitalised for the first time for an exacerbation of COPD (2004–2006). Patients were extensively characterised using sociodemographic, clinical and functional variables, and the cohort was followed-up through 2008. We defined “undiagnosed COPD” by the absence of any self-reported respiratory disease and regular use of any pharmacological respiratory treatment.

Results

Undiagnosed COPD was present in 34% of patients. They were younger (mean age 66 vs. 68 years, p = 0.03), reported fewer symptoms (mMRC dyspnoea score, 2.1 vs. 2.6, p < 0.01), and had a better health status (SGRQ total score, 29 vs. 40, p < 0.01), milder airflow limitation (FEV1% ref., 59% vs. 49%, p < 0.01), and fewer comorbidities (two or more, 40% vs. 56%, p < 0.01) when compared with patients with an established COPD diagnosis. Three months after hospital discharge, 16% of the undiagnosed COPD patients had stopped smoking (vs. 5%, p = 0.019). During follow-up, annual hospitalisation rates were lower in undiagnosed COPD patients (0.14 vs. 0.25, p < 0.01); however, this difference disappeared after adjustment for severity. Mortality was similar in both groups.

Conclusions

Undiagnosed COPD patients have less severe disease and lower risk of re-hospitalisation when compared with hospitalised patients with known COPD.
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