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Pooled Cohort Probability Score for Subclinical Airflow Obstruction.
Surya P Bhatt1,2, Pallavi P Balte3, Joseph E Schwartz3,4
1Division of Pulmonary, Allergy, and Critical Care Medicine.
Annals of the American Thoracic Society
|February 17, 2022
Summary
Early detection of subclinical airflow obstruction (SAO) is crucial for preventing chronic obstructive pulmonary disease (COPD) complications. A new probability score using common risk factors can help identify individuals needing spirometry for early diagnosis and intervention.
Area of Science:
- Pulmonary Medicine
- Epidemiology
- Public Health
Background:
- Early detection of chronic obstructive pulmonary disease (COPD) is a public health priority.
- Airflow obstruction is a key risk factor for COPD, but spirometry is not routinely used for screening.
- Subclinical airflow obstruction (SAO) represents an early stage of this condition.
Purpose of the Study:
- To determine the prevalence of SAO in the general population.
- To develop and validate a predictive score for SAO using readily available clinical data.
- To inform targeted screening and prevention strategies for COPD.
Main Methods:
- Pooled data from nine U.S. general population cohorts, excluding individuals with respiratory symptoms or prior diagnoses.
- Developed a probability score for SAO (defined as FEV1/FVC < 0.70) using hierarchical group-lasso regularization.
- Validated the score's discriminative accuracy in an external cohort (NHANES 2011-2012) and assessed its association with respiratory events.
Main Results:
- 13.2% of 33,546 participants had prevalent SAO.
- SAO was associated with a threefold higher incidence of respiratory hospitalizations and deaths.
- The developed probability score demonstrated excellent discrimination (C-statistic 0.81-0.83) and identified individuals for whom spirometry would be beneficial.
Conclusions:
- Subclinical airflow obstruction is prevalent and linked to increased respiratory morbidity and mortality.
- A probability score based on common clinical factors can effectively identify individuals at risk for SAO.
- This score can guide targeted screening and primary prevention efforts for COPD.
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