Population-based case-finding to identify subjects with undiagnosed asthma or COPD

Population-based case-finding to identify subjects with undiagnosed asthma or COPD

Population-based case-finding to identify subjects with undiagnosed asthma or COPDPopulation-based case-finding to identify subjects with undiagnosed asthma or COPD

Matthew Preteroti, G. Alex Whitmore,Katherine L. Vandemheen, J. Mark FitzGerald, Catherine Lemière, Louis-Philippe Boulet, Erika Penz, Stephen K. Field, Samir Gupta, R. Andrew McIvor, Irvin Mayers, Paul Hernandez, Diane Lougheed, Martha Ainslie, Christopher Licskai, Tanweer Azher, Ian Fraser, Masoud Mahdavian, Shawn D. Aaron

European Respiratory Journal 2020 55: 2000024; DOI: 10.1183/13993003.00024-2020

Abstract
Background ∼5–10% of adults may have undiagnosed airflow obstruction. The objective of this study was to develop a population-based case-finding strategy to assess the prevalence of undiagnosed airflow obstruction (asthma or COPD) amongst adults with respiratory symptoms in Canada.

Methods Adults without a previous history of asthma, COPD or lung disease were recruited using random digit-dialling and asked if they had symptoms of dyspnoea, cough, sputum or wheeze within the past 6 months. Those who answered affirmatively completed the Asthma Screening Questionnaire (ASQ), COPD-Diagnostic Questionnaire (COPD-DQ) and COPD Assessment Test (CAT). Those with an ASQ score of ≥6 or a COPD-DQ score of ≥20 underwent pre- and post-bronchodilator spirometry to diagnose asthma or COPD.

Results 12 117 individuals were contacted at home and assessed for study eligibility. Of the 1260 eligible individuals, 910 (72%) enrolled and underwent spirometry. Ultimately, 184 subjects (20% of those enrolled) had obstructive lung disease (73 asthma and 111 COPD). Individuals found to have undiagnosed asthma or COPD had more severe respiratory symptoms and impaired quality of life compared with those without airflow obstruction. The ASQ, COPD-DQ, and CAT had ROC areas for predicting undiagnosed asthma or COPD of 0.49, 0.64 and 0.56, respectively. Four descriptive variables (age, BMI, sex and pack-years smoked) produced better receiver operating characteristic (ROC) values than the questionnaires (ROC area=0.68).

Conclusion 20% of randomly selected individuals who report respiratory symptoms in Canada have undiagnosed airflow obstruction due to asthma or COPD. Questionnaires could exclude subjects at low risk but lack the ability to accurately find subjects with undiagnosed disease.

20% of randomly selected individuals who report respiratory symptoms in Canada have undiagnosed airflow obstruction due to asthma or COPD http://bit.ly/2WdXlaH

Footnotes
This article has an editorial commentary: https://doi.org/10.1183/13993003.01514-2020

This article has supplementary material available from erj.ersjournals.com

Author contributions: Conception and design: S.D. Aaron and G.A. Whitmore. Analysis and interpretation: M. Preteroti, G.A. Whitmore and S.D. Aaron. Drafting the manuscript for important intellectual content: M. Preteroti, G.A. Whitmore, S.D. Aaron, K.L. Vandemheen, J.M. FitzGerald, C. Lemière, L-P. Boulet, E. Penz, S.K. Field, S. Gupta, R.A. McIvor, I. Mayers, P. Hernandez, D. Lougheed, M. Ainslie, C. Licskai, T. Azher, I. Fraser and M. Mahdavian.

Conflict of interest: M. Preteroti has nothing to disclose.

Conflict of interest: G.A. Whitmore has nothing to disclose.

Conflict of interest: K.L. Vandemheen has nothing to disclose.

Conflict of interest: J.M. FitzGerald has nothing to disclose.

Conflict of interest: C. Lemiere reports grants and personal fees for advisory board work, consultancy and lectures from AstraZeneca, grants and personal fees for advisory board work and lectures from TEVA Innovation, personal fees for advisory board work and consultancy from GlaxoSmithKline, personal fees for advisory board work from Sanofi, outside the submitted work.

Conflict of interest: L-P. Boulet reports research grants for participation in multicentre studies from AstraZeneca, Boston Scientific, GlaxoSmithKline, Hoffman La Roche, Novartis, Ono Pharma, Sanofi and Takeda, support for research projects introduced by the investigator from AstraZeneca, Boehringer Ingelheim, GlaxoSmithKline, Merck and Takeda, fees for consulting and advisory boards from AstraZeneca, Novartis and Methapharm, nonprofit grants for production of educational materials from AstraZeneca, Boehringer Ingelheim, GlaxoSmithKline, Merck and Novartis, conference fees from AstraZeneca, GlaxoSmithKline, Merck and Novartis, support for participation in conferences and meetings from Novartis and Takeda.

Conflict of interest: E. Penz reports CIHR funding of UCAP study, during the conduct of the study; grants, personal fees for advisory board work, consultancy and lectures, and non-financial (travel) support from AstraZeneca, personal fees for advisory board work and non-financial (travel) support from GlaxoSmithKline and Boehringer Ingelheim, outside the submitted work.

Conflict of interest: S.K. Field reports grants from GSK, InsMed, Novartis and Boehringer Ingelheim, outside the submitted work.

Conflict of interest: S. Gupta has nothing to disclose.

Conflict of interest: R.A. McIvor has nothing to disclose.

Conflict of interest: I. Mayers has nothing to disclose.

Conflict of interest: P. Hernandez reports grants from CIHR, during the conduct of the study; personal fees for consultancy from Actelion, GlaxoSmithKline, Novartis, Sanofi and Teva, personal fees for consultancy and educational activities from AstraZeneca, grants and personal fees for consultancy and educational activities from Boehringer Ingelheim, grants from Cyclomedica, Grifols and Prometic, outside the submitted work.

Conflict of interest: D. Lougheed reports grants from AstraZeneca, GlaxoSmithKline, Hoffman LaRoche Ltd, Novartis, Government of Ontario’s Innovation Fund, Allergen NCE, Janssen, Canadian Institutes of Health Research, Manitoba Workers Compensation Board and Ontario Lung Association/Canada Health Infoway, grants and honoraria for educational activities from Ontario Lung Association, honoraria for educational activities from Canadian Thoracic Society, honoraria for advisory board work from AstraZeneca PRECISION Program, outside the submitted work; and is the nominated Canadian Thoracic Society representative on the Canadian Lung Association’s Board of Directors.

Conflict of interest: M. Ainslie has nothing to disclose.

Conflict of interest: C. Licskai reports grants and personal fees from AstraZeneca, Boehringer Ingelheim, Novartis and Pfizer, personal fees from GSK, outside the submitted work.

Conflict of interest: T. Azher has nothing to disclose.

Conflict of interest: I. Fraser has nothing to disclose.

Conflict of interest: M. Madavian reports personal fees for lectures from AstraZeneca, personal fees for lectures and non-financial (drug sample) support from Novartis and Boehringer Ingelheim, non-financial (drug sample) support from GSK, outside the submitted work.

Conflict of interest: S.D. Aaron has nothing to disclose.

Support statement: This work was supported by the Canadian Institutes of Health Research, FDN grant 154322. Funding information for this article has been deposited with the Crossref Funder Registry.

Received January 6, 2020.
Accepted March 8, 2020.

 

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