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

Journal article

Balcells, Eva, Gimeno-Santos, Elena, de Batlle, Jordi, Ramon, Maria Antonia, Rodríguez, Esther, Benet, Marta, Farrero, Eva, Ferrer, Antoni, Guerra, Stefano, Ferrer, Jaume, Sauleda, Jaume, Barberà, Joan A., Agustí, Àlvar, Rodriguez-Roisin, Robert, Gea, Joaquim, Antó, Josep M., Garcia-Aymerich, Judith, the, P. A. C. Copd Study Group and Donaire Gonzalez, David. (2015). Characterisation and prognosis of undiagnosed chronic obstructive pulmonary disease patients at their first hospitalisation. BMC Pulmonary Medicine. 15(1), p. Article 4. https://doi.org/10.1186/1471-2466-15-4
AuthorsBalcells, Eva, Gimeno-Santos, Elena, de Batlle, Jordi, Ramon, Maria Antonia, Rodríguez, Esther, Benet, Marta, Farrero, Eva, Ferrer, Antoni, Guerra, Stefano, Ferrer, Jaume, Sauleda, Jaume, Barberà, Joan A., Agustí, Àlvar, Rodriguez-Roisin, Robert, Gea, Joaquim, Antó, Josep M., Garcia-Aymerich, Judith, the, P. A. C. Copd Study Group and Donaire Gonzalez, David
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.

Keywordspulmonary disease; chronic obstructive; hospitalisation; cohort studies; epidemiology; health services
Year2015
JournalBMC Pulmonary Medicine
Journal citation15 (1), p. Article 4
PublisherBiomed Central Ltd
ISSN1471-2466
Digital Object Identifier (DOI)https://doi.org/10.1186/1471-2466-15-4
Scopus EID2-s2.0-84925234718
Open accessPublished as ‘gold’ (paid) open access
Research or scholarlyResearch
Page range1-9
Publisher's version
License
File Access Level
Open
Output statusPublished
Publication dates
Online17 Jan 2015
Publication process dates
Accepted08 Jan 2015
Deposited09 Sep 2021
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Acute respiratory response to traffic-related air pollution during physical activity performance
Matt, Florian, Cole-Hunter, Tom, Donaire-Gonzalez, David, Kubesch, Nadine, Martínez, David, Carrasco-Turigas, Glòria and Nieuwenhuijsen, Mark. (2016). Acute respiratory response to traffic-related air pollution during physical activity performance. Environment International. 97, pp. 45 - 55. https://doi.org/10.1016/j.envint.2016.10.011
Spatiotemporally resolved black carbon concentration, schoolchildren's exposure and dose in Barcelona
Rivas, Ioar, Donaire-Gonzalez, David, Bouso, L., Esnaola, Mikel, Pandolfi, M., de Castro, Montserrat, Viana, M., Alvarez-Pedrerol, Mar, Nieuwenhuijsen, Mark J., Alastuey, A., Sunyer, Jordi and Querol, Xavier. (2016). Spatiotemporally resolved black carbon concentration, schoolchildren's exposure and dose in Barcelona. Indoor Air. 26(3), pp. 391 - 402. https://doi.org/10.1111/ina.12214
Short-term planning and policy interventions to promote cycling in urban centers: Findings from a commute mode choice analysis in Barcelona, Spain
Braun, Lindsay M., Rodríguez, Daniel A., Cole-Hunter, Tom, Ambros, Albert, Donaire-Gonzalez, David, Jerrett, Michael, Mendez, Michelle A., Nieuwenhuijsen, Mark J. and de Nazelle, Audrey. (2016). Short-term planning and policy interventions to promote cycling in urban centers: Findings from a commute mode choice analysis in Barcelona, Spain. Transportation Research Part A. 89, pp. 164 - 183. https://doi.org/10.1016/j.tra.2016.05.007
Inspiratory capacity-to-total lung capacity ratio and dyspnoea predict exercise capacity decline in COPD
Ramon, Maria A., Ferrer, Jaume, Gimeno-Santos, Elena, Donaire-Gonzalez, David, Rodríguez, Esther, Balcells, Eva, de Batlle, Jordi, Benet, Marta, Guerra, Stefano, Sauleda, Jaume, Ferrer, Antoni, Farrero, Eva, Gea, Joaquim, Barberà, Joan A., Agustí, Àlvar, Rodriguez-Roisin, Robert, Antó, Josep M. and Garcia-Aymerich, Judith. (2016). Inspiratory capacity-to-total lung capacity ratio and dyspnoea predict exercise capacity decline in COPD. Respirology. 21(3), pp. 476 - 482. https://doi.org/10.1111/resp.12723
The added benefit of bicycle commuting on the regular amount of physical activity performed
Donaire-Gonzalez, David, de Nazelle, Audrey, Cole-Hunter, Tom, Curto, Ariadna, Rodríguez, Daniel A., Mendez, Michelle A., Garcia-Aymerich, Judith, Basagaña, Xavier, Ambros, Albert, Jerrett, Michael and Nieuwenhuijsen, Mark J.. (2015). The added benefit of bicycle commuting on the regular amount of physical activity performed. American Journal of Preventive Medicine. 49(6), pp. 842 - 849. https://doi.org/10.1016/j.amepre.2015.03.036
Objective correlates and determinants of bicycle commuting propensity in an urban environment
Cole-Hunter, Tom, Donaire-Gonzalez, David, Curto, A., Ambros, Albert, Valentín, Antònia, Garcia-Aymerich, J., Martínez, David, Braun, Lindsay M., Mendez, Michelle, Jerrett, Michael, Rodríguez, Daniel A., de Nazelle, Audrey and Nieuwenhuijsen, Mark J.. (2015). Objective correlates and determinants of bicycle commuting propensity in an urban environment. Transportation Research Part D. 40, pp. 132 - 143. https://doi.org/10.1016/j.trd.2015.07.004
Benefits of physical activity on COPD hospitalisation depend on intensity
Donaire-Gonzalez, David, Gimeno-Santos, Elena, Balcells, Eva, De Batlle, Jordi, Ramon, Maria A., Rodriguez, Esther, Farrero, Eva, Benet, Marta, Guerra, Stefano, Sauleda, Jaume, Ferrer, Antoni, Barberà, Joan A., Rodriguez-Roisin, Robert, Gea, Joaquim, Agusti, Alvar, Antó, Josep M., Garcia-Aymerich, Judith, PAC-COPD Study Group, , Ferrer, Jaume and PAC-COPD Study Group. (2015). Benefits of physical activity on COPD hospitalisation depend on intensity. European Respiratory Journal. 46(5), pp. 1281 - 1289. https://doi.org/10.1183/13993003.01699-2014
Positive health effects of the natural outdoor environment in typical populations in different regions in Europe (PHENOTYPE): A study programme protocol
Nieuwenhuijsen, Mark J., Kruize, Hanneke, Gidlow, Christopher, Andrusaityte, Sandra, Antó, Josep M., Basagaña, Xavier, Cirach, Marta, Dadvand, Payam, Danileviciute, Asta, Donaire-Gonzalez, David, Garcia, Judith, Jerrett, Michael, Jones, Marc V., Julvez, Jordi, van Kempen, Elise, van Kamp, Irene, Maas, Jolanda, Seto, Edmund, Smith, Graham, ... Gražulevičienė, Regina. (2014). Positive health effects of the natural outdoor environment in typical populations in different regions in Europe (PHENOTYPE): A study programme protocol. BMJ Open. 4(4), pp. 1 - 11. https://doi.org/10.1136/bmjopen-2014-004951
Lifetime occupational exposure to dusts, gases and fumes is associated with bronchitis symptoms and higher diffusion capacity in COPD patients
Rodríguez, Esther, Ferrer, Jaume, Zock, Jan-Paul, Serra, Ignasi, Antó, Josep M., De Batlle, Jordi, Kromhout, Hans, Vermeulen, Roel, Donaire-Gonzalez, David, Benet, Marta, Balcells, Eva, Monso, Eduard, Gayete, Angel, Garcia-Aymerich, J., Guerra, Stefano, Gea, Joaquim, Orozco-Levi, Mauricio, Vollmer, Ivan, Barberà, Joan A., ... Belda, José. (2014). Lifetime occupational exposure to dusts, gases and fumes is associated with bronchitis symptoms and higher diffusion capacity in COPD patients. PLoS ONE. 9(2), pp. 1 - 7. https://doi.org/10.1371/journal.pone.0088426
Using personal sensors to assess the exposome and acute health effects
Nieuwenhuijsen, Mark J., Donaire-Gonzalez, David, Foraster, Maria, Martínez, David and Cisneros, Andres. (2014). Using personal sensors to assess the exposome and acute health effects. International Journal of Environmental Research and Public Health. 11(8), pp. 7805 - 7819. https://doi.org/10.3390/ijerph110807805
Physical activity in COPD patients : Patterns and bouts
Donaire-Gonzalez, David, Gimeno-Santos, Elena, Balcells, Eva, Rodríguez, Diego A., Farrero, Eva, de Batlle, Jordi, Benet, Marta, Ferrer, Antoni, Barberà, Joan A., Gea, Joaquim, Rodriguez-Roisin, Robert, Antó, Josep M. and Garcia-Aymerich, Judith. (2013). Physical activity in COPD patients : Patterns and bouts. European Respiratory Journal. 42(4), pp. 993-1002. https://doi.org/10.1183/09031936.00101512
Comparison of physical activity measures using mobile phone-based calfit and actigraph
Donaire-Gonzalez, David, de Nazelle, Audrey, Seto, Edmund, Mendez, Michelle, Nieuwenhuijsen, Mark J. and Jerrett, Michael. (2013). Comparison of physical activity measures using mobile phone-based calfit and actigraph. Journal of Medical Internet Research. 15(6), p. e111. https://doi.org/10.2196/jmir.2470
Improving estimates of air pollution exposure through ubiquitous sensing technologies
de Nazelle, Audrey, Seto, Edmund, Donaire-Gonzalez, David, Mendez, Michelle, Matamala, Jaume, Nieuwenhuijsen, Mark J. and Jerrett, Michael. (2013). Improving estimates of air pollution exposure through ubiquitous sensing technologies. Environmental Pollution. 176, pp. 92 - 99. https://doi.org/10.1016/j.envpol.2012.12.032
Effect of bronchial colonisation on airway and systemic inflammation in stable COPD
Marin, Alicia, Garcia-Aymerich, Judith, Sauleda, Jaume, Belda, Jose, Millares, Laura, García-Núñez, Marian, Serra, Ignasi, Benet, Marta, Agustí, Alvar, Antó, Josep M., Monsó, Eduard, PAC-COPD Study Group and Donaire-Gonzalez, David. (2012). Effect of bronchial colonisation on airway and systemic inflammation in stable COPD. COPD. 9(2), pp. 121-130. https://doi.org/10.3109/15412555.2011.636407
Cured meat consumption increases risk of readmission in COPD patients
Jordi de Batlle, Mendez, Michelle, Romieu, Isabelle, Balcells, Eva, Benet, Marta, Donaire-Gonzalez, David, Ferrer, Jaume J., Orozco-Levi, Mauricio, Antó, Josep M., Garcia-Aymerich, Judith and PAC-COPD Study Group. (2012). Cured meat consumption increases risk of readmission in COPD patients. European Respiratory Journal. 40(3), pp. 555-560. https://doi.org/10.1183/09031936.00116911
Specific IgA and metalloproteinase activity in bronchial secretions from stable chronic obstructive pulmonary disease patients colonized by Haemophilus influenzae
Millares, Laura, Marin, Alicia, Garcia-Aymerich, J., Sauleda, Jaume, Belda, José, Monso, Eduard, Antó, Josep M., Benet, Marta, De Batlle, Jordi, Serra, Ignasi, Donaire Gonzalez, David, Guerra, Stefano, Gea, Joaquim, Balcells, Eva, Gayete, ADavidngel, Orozco-Levi, Mauricio, Vollmer, Ivan, Barberà, Joan A., Gomez, Federico P., ... Pallissa, Esther. (2012). Specific IgA and metalloproteinase activity in bronchial secretions from stable chronic obstructive pulmonary disease patients colonized by Haemophilus influenzae. Respiratory Research. 13(1). https://doi.org/10.1186/1465-9921-13-113
Validation of the Yale Physical Activity Survey in Chronic Obstructive Pulmonary Disease Patients
Donaire-Gonzalez, David, Gimeno-Santos, Elena, Serra, Ignasi, Roca, Josep, Balcells, Eva, Rodríguez, Esther, Farrero, Eva, Antó, Josep M. and Garcia-Aymerich, Judith. (2011). Validation of the Yale Physical Activity Survey in Chronic Obstructive Pulmonary Disease Patients. Archivos de Bronconeumología. 47(11), pp. 552-560.