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Am J Respir Crit Care Med. 2016 Aug 1;194(3):285-98. doi: 10.1164/rccm.201509-1795OC.

Undiagnosed Chronic Obstructive Pulmonary Disease Contributes to the Burden of Health Care Use. Data from the CanCOLD Study.

Author information

1
1 Respiratory Epidemiology and Clinical Research Unit, Research Institute of the McGill University Health Centre, and.
2
2 University of British Columbia, Vancouver, British Columbia, Canada.
3
3 Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
4
4 Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada.
5
5 University of Toronto, Toronto, Ontario, Canada.
6
6 University of Calgary, Calgary, Alberta, Canada.
7
7 Dalhousie University, Halifax, Nova Scotia, Canada.
8
8 Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec, Québec, Canada.
9
9 University of Saskatchewan, Saskatoon, Saskatchewan, Canada; and.
10
10 Queens University, Kingston, Ontario, Canada.

Abstract

RATIONALE:

Chronic obstructive pulmonary disease (COPD) remains undiagnosed in many individuals with persistent airflow limitation. These individuals may be susceptible to exacerbation-like respiratory events that consume health care resources.

OBJECTIVES:

To compare exacerbation-like respiratory events, event prevalence, and differences in the odds of using medication and/or health services between subjects with diagnosed and undiagnosed COPD.

METHODS:

Subjects sampled from the general population participating in the CanCOLD (Canadian Cohort Obstructive Lung Disease) study, with at least 12 months of exacerbation-event follow-up who were classified as having physician-diagnosed or undiagnosed COPD were assessed. Exacerbation-like respiratory events were captured using a questionnaire administered every 3 months.

MEASUREMENTS AND MAIN RESULTS:

A total of 355 subjects were undiagnosed and 150 were diagnosed with COPD. Undiagnosed subjects were less symptomatic and functionally impaired, had been prescribed fewer respiratory medications, and had better health status. The incidence of reported exacerbation-like events was higher in diagnosed subjects and increased in both groups with the severity of airflow obstruction. Although subjects with diagnosed COPD were more often prescribed medication for exacerbation events, health service use for exacerbation events was similar in both groups.

CONCLUSIONS:

Most subjects with COPD in Canada remain undiagnosed. These subjects are less symptomatic and impaired, which may partly explain lack of diagnosis. Although patients with undiagnosed COPD experience fewer exacerbations than those with diagnosed COPD, they use a similar amount of health services for exacerbation events; thus, the overall health system burden of exacerbations in those with undiagnosed COPD is considerable.

KEYWORDS:

burden; exacerbation; undiagnosed COPD

Comment in

PMID:
26836958
DOI:
10.1164/rccm.201509-1795OC
[Indexed for MEDLINE]

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