Patients With Persistent Cough, Sputum Actually Had Airway Obstruction Consistent With COPD

Ruzanna Harutyunyan's picture
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GlaxoSmithKline (NYSE: GSK) today announced findings from a cross-sectional study which showed that 26 percent of primary care patients 40 years of age and older with a history of smoking and symptoms of chronic bronchitis actually had airway obstruction consistent with chronic obstructive pulmonary disease (COPD) - yet were not diagnosed with the disease.

The data also show that as age and smoking history increased the percent of patients with COPD increased - roughly half (49%) of the patients over 60 years of age with more than a 20-pack year history of smoking had an FEV(1) (forced expiratory flow in one second)/FVC (forced vital capacity) ratio consistent with COPD; 40 percent of patients over 50 years of age who had more than a 30-pack year history of smoking also had FEV(1)/FVC consistent with COPD. For the group over 70 years of age with more than a 40-pack year history, the percent increased to 72.

Overall, only 4 percent of patients in this study had been diagnosed with COPD by their clinician. These data were presented in Philadelphia at CHEST 2008, the annual meeting of the American College of Chest Physicians.

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"Understanding the patients who are at greatest risk for having undiagnosed COPD should help improve disease recognition, diagnosis and management," said Barbara Yawn, M.D., lead author and director of research at the Olmsted Medical Center, Rochester, MN. "Spirometry should be considered in anyone with symptoms and a 10 or greater pack-year smoking history - which is how we will improve recognition of COPD."

In the study, pre- and post-bronchodilatory spirometry was performed on all patients. Albuterol was self-administered for determination of post- bronchodilator FEV(1)/FVC ratio, post-albuterol FEV(1)% of predicted normal and FEV(1) reversibility. All patients had self-reported symptoms of chronic bronchitis and were current or previous cigarette smokers with a history of cigarette smoking of > or = 10 pack-years. COPD was defined as a post- bronchodilator FEV(1)/FVC < or = 0.7.

COPD is characterized by a progressive airflow limitation that is not fully reversible and is associated with an abnormal inflammatory response of the lungs, primarily caused by smoking. The range of conditions described by COPD, which include chronic bronchitis and emphysema, has led to confusion about disease terminology and difficulty with diagnosis especially in the primary care setting. Despite the availability of effective medicines to help manage the disease, many patients with COPD remain undiagnosed and under- treated. This study aimed to characterize airway obstruction, patient characteristics, and patient and provider awareness and understanding of COPD in primary care patients with symptoms of chronic bronchitis.

About the Study

This was a multi-center, cross-sectional study of more than 1,200 subjects 40 years of age and older with a minimum 10 pack-year smoking history and symptoms of chronic bronchitis recruited from primary care centers. There was no treatment intervention in the study. Each study subject completed a single visit encompassing all study procedures, which included two questionnaires completed by each study subject. One questionnaire was a compilation of the medical research council (MRC) dyspnea scale, the 12-item Short Form Health Survey (SF-12, version 2), a modified American Thoracic Society (ATS) respiratory questionnaire, and additional questions about disease and smoking history, work and non-work activities missed due to breathing problems. The other questionnaire, The Lung Function Questionnaire (LFQ), was comprised of seven questions related to respiratory symptoms, smoking history and age.

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