Validation of a Chronic Obstructive Pulmonary Disease (COPD) Predictive Algorithm
Wake Forest University Health Sciences
Summary
Under-diagnosis of Chronic Obstructive Pulmonary Disease (COPD) is prevalent, with an estimated 75% of adults suffering from COPD in the US, without clinical recognition. Often, the first diagnosis of COPD comes with a flare or exacerbation. In one study, 34% of patients were first diagnosed during hospitalization for an exacerbation, an event associated with a 1-year mortality rate of 26%. When COPD is finally diagnosed, it is often in the late stages, with an average lung function of 50% of normal. Conversely, COPD can be over-diagnosed, defined as symptoms in an individual without airflow obstruction. Over-diagnosed people have significantly higher rates of hospitalization, ER visits, and ambulatory care visits because individuals are treated for a disorder they don't have and are not being treated for the disorder they do have. Lack of diagnostic clarity places patients at risk of medication complications without potential benefit. Conversely, failure to diagnose preempts the benefits of therapy. To date, no reliable solution has been found to address this problem.
Description
Guideline based therapy for COPD includes bronchodilators in conjunction with smoking cessation, vaccination and pulmonary rehabilitation. Bronchodilators have repeatedly been shown to improve symptoms, lung function and quality of life and to reduce exacerbations and possibly mortality in individuals with documented COPD. Despite these findings, the US Preventive Services Task Force recommends against screening for COPD because its value has not been demonstrated in "asymptomatic" individuals. Symptoms such as cough, dyspnea, and wheezing are nonspecific and are common in other disorders such…
Eligibility
- Age range
- 40+ years
- Sex
- All
- Healthy volunteers
- No
Inclusion Criteria: * greater thank or equal to 40 years of age * 2 or more encounters in the health system * Previous Pulmonary Function Test (PFT) recorded in our Electronic Health Records (EHR) in the previous 5 years Exclusion Criteria: * cystic fibrosis * Alpha-1 Antitrypsin Deficiency (AAD)currently pregnant * History of a lung transplant or partial removal of the lung * significant chest wall deformity * neuromuscular disease that currently impacts the respiratory muscles * surgery requiring general anesthesia or an overnight stay in the hospital within the past 30 days
Location
- Wake Forest University Health SciencesWinston-Salem, North Carolina