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Clinical Validation of a Multidimensional Diagnostic Approach for COPD in Chinese Individuals
Fan Wu1, Suyin Huang1, Kunning Zhou2
1State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease & National Center for Respiratory Medicine & Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China; Guangzhou National Laboratory, Guangzhou, China.
Background:
Although spirometry is used to diagnose COPD, a new multidimensional diagnostic schema has recently been proposed to diagnose this disease. However, evidence in Chinese individuals and those who never smoked is limited.
Research Question:
Is the new multidimensional diagnostic method for COPD practical in the Chinese population and individuals who never smoked?
Study Design And Methods:
We analyzed data from a 3-year, prospective, multicenter, community-based cohort study. The previous diagnostic criterion for COPD was postbronchodilator FEV1/FVC < 0.70. The new multidimensional diagnostic schema includes the major diagnostic category (presence of the major criterion and at least 1 of 5 minor criteria) and the minor diagnostic category (presence of least 3 of 5 minor criteria). The main criterion is postbronchodilator FEV1/FVC < 0.70. The minor criteria include emphysema, bronchial wall thickening, dyspnea, poor quality of life, and chronic bronchitis. A subgroup analysis was conducted among individuals who never smoked.
Results:
Among participants without airflow obstruction, 4.8% (55 of 1,140) met the multidimensional diagnostic criteria; 5.8% (53 of 915) of participants with airflow obstruction did not meet these criteria. Participants with airflow obstruction who were excluded using the multidimensional diagnostic schema for COPD had a risk of exacerbations and annual decline in lung function similar to that in participants diagnosed as normal using both criteria. Participants without airflow obstruction reclassified as having COPD had a higher risk of exacerbations compared with those diagnosed as normal using both criteria. Similar results were found in individuals who never smoked.
Interpretation:
Our results show that the new multidimensional diagnostic schema for COPD can exclude individuals with airflow obstruction who have a favorable respiratory prognosis and identify those without airflow obstruction who are at higher risk for exacerbations in Chinese individuals and those who never smoked.
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