Dataset Information

The Effect of a Post-Bronchodilator FEV₁/FVC < 0.7 on COPD Diagnosis and Treatment: A Regression Discontinuity Design.

ABSTRACT:

Background

Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines recommend the diagnosis of chronic obstructive pulmonary disease (COPD) only in patients with a post-bronchodilator forced expiratory volume in 1 second to forced vital capacity ratio (FEV₁/FVC) less than 0.7. However the impact of this recommendation on clinical practice is unknown.

Research question

What is the effect of a documented post-bronchodilator FEV₁/FVC < 0.7 on the diagnosis and treatment of COPD?

Study design and methods

We used a national electronic health record database to identify clinical encounters between 2007 to 2022 with patients 18 years of age and older in which a post-bronchodilator FEV₁/FVC value was documented. An encounter was associated with a COPD diagnosis if a diagnostic code for COPD was assigned, and was associated with COPD treatment if a prescription for a medication commonly used to treat COPD was filled within 90 days. We used a regression discontinuity design to measure the effect of a post-bronchodilator FEV₁/FVC < 0.7 on COPD diagnosis and treatment.

Results

Among 27 817 clinical encounters, involving 18 991 patients, a post-bronchodilator FEV₁/FVC < 0.7 was present in 14 876 (53.4%). The presence of a documented post-bronchodilator FEV₁/FVC < 0.7 had a small effect on the probability of a COPD diagnosis, increasing by 6.0% (95% confidence interval [CI] 1.1% to 10.9%) from 38.0% just above the 0.7 cutoff to 44.0% just below this cutoff. The presence of a documented post-bronchodilator FEV₁/FVC had no effect on the probability of COPD treatment (-2.1%, 95% CI -7.2% to 3.0%).

Interpretation

The presence of a documented post-bronchodilator FEV₁/FVC < 0.7 has only a small effect on the probability that a clinician will make a guideline-concordant diagnosis of COPD and has no effect on corresponding treatment decisions.

SUBMITTER: Moffett AT

PROVIDER: S-EPMC11326314 | biostudies-literature | 2024 Aug

REPOSITORIES: biostudies-literature

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Publications

The Effect of a Post-Bronchodilator FEV<sub>1</sub>/FVC < 0.7 on COPD Diagnosis and Treatment: A Regression Discontinuity Design.

Moffett Alexander T AT Halpern Scott D SD Weissman Gary E GE

medRxiv : the preprint server for health sciences 20240806

<h4>Background</h4>Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines recommend the diagnosis of chronic obstructive pulmonary disease (COPD) only in patients with a post-bronchodilator forced expiratory volume in 1 second to forced vital capacity ratio (FEV<sub>1</sub>/FVC) less than 0.7. However the impact of this recommendation on clinical practice is unknown.<h4>Research question</h4>What is the effect of a documented post-bronchodilator FEV<sub>1</sub>/FVC < 0.7 on the ...[more]

PMID: 39148856

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Project description:Rationale: According to the Global Initiative for Obstructive Lung Disease (GOLD), the FEV1/FVC ratio is used to confirm the presence of airflow obstruction in the diagnosis of chronic obstructive pulmonary disease (COPD), whereas FEV1 percent predicted normal value (FEV1%pred) is used for grading its severity. The STaging of Airflow obstruction by the FEV1/FVC Ratio (STAR), and its prediction of adverse outcomes, has not been evaluated in general populations. Objectives: To compare the STAR (FEV1/FVC) and the GOLD (FEV1%pred) classifications for the severity of airflow limitation in terms of exertional breathlessness and mortality in the general U.S. population. Methods: Severity stages according to the STAR and GOLD were applied to the multiethnic National Health and Nutrition Examination Survey of 2007-2012, including people ages 18-80 years, using a postbronchodilatory FEV1/FVC ratio of <0.70 to define airflow obstruction in both staging systems. Prevalence of the severity stages STAR 1-4 and GOLD 1-4 was calculated, and associations with breathlessness and mortality were analyzed by multinomial logistic regression and Cox regression, respectively. Measurements and Main Results: STAR versus GOLD severity staging of airflow obstruction showed similar associations with breathlessness and all-cause mortality, regardless of ethnicity and/or race. In those with airflow obstruction, the correlation between the two classification systems was 0.461 (P < 0.001). STAR reclassified 59% of GOLD 2 subjects as having mild airflow obstruction (STAR 1). Compared with GOLD 1, STAR 1 was more clearly differentiated from nonobstruction in terms of both breathlessness and mortality. Conclusions: FEV1/FVC and FEV1%pred as measures of airflow limitation severity show similar predictions of breathlessness and mortality in the adult U.S. population across ethnicity groups. However, Stage 1 differed more clearly from nonobstruction on the basis of FEV1/FVC ratio than FEV1%pred.

Project description:BackgroundThe ratio of the forced expiratory volume in 1 s (FEV1) to the forced vital capacity (FVC) is an essential tool for the diagnosis of chronic obstructive pulmonary disease (COPD). However, the relationship between levels of FEV1/FVC and mortality in the general population remains unclear, particularly its non-linear relationship. Therefore, we aimed to explore the association between the FEV1/FVC and all-cause mortality in the general population.MethodsThe data of participants included in the National Health and Nutrition Examination Survey (1988-1994 and 2007-2012 cycles) were analyzed. Participants aged ≥20 years, who were not pregnant, who underwent quality-controlled lung function tests, and with follow-up data on mortality status were enrolled. The study outcome was all-cause mortality. The participants were grouped by FEV1/FVC ratio in 0.10 increments. Cox proportional-hazards models were used to estimate the association between the FEV1/FVC ratio and all-cause mortality before and after confounder adjustment. Non-linear associations were explored using restricted cubic spline curves.ResultsOverall, 25,501 participants were included. During the median follow up of 308 months, 6431 (25.2%) deaths were recorded. Among all participants, the mean age is 46.3 years, and 48.7% of which were male. In unadjusted model, individuals with an FEV1/FVC ratio < 0.90 had an increased risk of all-cause mortality compared to those with an FEV1/FVC ratio ≥ 0.90. After adjusting for age, sex, body mass index, race, and smoking status, participants in the 0.60 ≤ FEV1/FVC < 0.90 group had a lower all-cause mortality risk than those in the FEV1/FVC ≥ 0.90 group, while the mortality risk of individuals with an FEV1/FVC ratio < 0.50 was higher. Restricted cubic splines revealed a U-shaped association between the FEV1/FVC ratio and all-cause mortality. Below and above the inflection point, an inverse trend was observed.ConclusionOur study first revealed a U-shaped association between the level of FEV1/FVC and all-cause mortality in general population.Clinical trial numberNot applicable.

Project description:RationaleQuantifying functional small airways disease (fSAD) requires additional expiratory computed tomography (CT) scan, limiting clinical applicability. Artificial intelligence (AI) could enable fSAD quantification from chest CT scan at total lung capacity (TLC) alone (fSADTLC).ObjectivesTo evaluate an AI model for estimating fSADTLC and study its clinical associations in chronic obstructive pulmonary disease (COPD).MethodsWe analyzed 2513 participants from the SubPopulations and InteRmediate Outcome Measures in COPD Study (SPIROMICS). Using a subset (n = 1055), we developed a generative model to produce virtual expiratory CTs for estimating fSADTLC in the remaining 1458 SPIROMICS participants. We compared fSADTLC with dual volume, parametric response mapping fSADPRM. We investigated univariate and multivariable associations of fSADTLC with FEV1, FEV1/FVC, six-minute walk distance (6MWD), St. George's Respiratory Questionnaire (SGRQ), and FEV1 decline. The results were validated in a subset (n = 458) from COPDGene study. Multivariable models were adjusted for age, race, sex, BMI, baseline FEV1, smoking pack years, smoking status, and percent emphysema.Measurements and main resultsInspiratory fSADTLC was highly correlated with fSADPRM in SPIROMICS (Pearson's R = 0.895) and COPDGene (R = 0.897) cohorts. In SPIROMICS, fSADTLC was associated with FEV1 (L) (adj.β = -0.034, P < 0.001), FEV1/FVC (adj.β = -0.008, P < 0.001), SGRQ (adj.β = 0.243, P < 0.001), and FEV1 decline (mL / year) (adj.β = -1.156, P < 0.001). fSADTLC was also associated with FEV1 (L) (adj.β = -0.032, P < 0.001), FEV1/FVC (adj.β = -0.007, P < 0.001), SGRQ (adj.β = 0.190, P = 0.02), and FEV1 decline (mL / year) (adj.β = -0.866, P = 0.001) in COPDGene. We found fSADTLC to be more repeatable than fSADPRM with intraclass correlation of 0.99 (95% CI: 0.98, 0.99) vs. 0.83 (95% CI: 0.76, 0.88).ConclusionsInspiratory fSADTLC captures small airways disease as reliably as fSADPRM and is associated with FEV1 decline.

Project description:BackgroundManagement strategies of chronic obstructive pulmonary disease (COPD) need to be tailored to the forced expiratory volume in one second (FEV1), exacerbations, and patient-reported outcomes (PROs) of individual patients. In this study, we analyzed the association and correlation between the FEV1, exacerbations, and PROs of patients with stable COPD.MethodsThis was a post-hoc analysis of pooled data from two cross-sectional studies that were previously conducted in Malaysia from 2017 to 2019, the results of which had been published separately. The parameters measured included post-bronchodilator FEV1 (PB-FEV1), exacerbations, and scores of modified Medical Research Council (mMRC), COPD Assessment Test (CAT), and St George's Respiratory Questionnaire for COPD (SGRQ-c). Descriptive, association, and correlation statistics were used.ResultsThree hundred seventy-four patients were included in the analysis. The PB-FEV1 predicted was < 30% in 85 (22.7%), 30-49% in 142 (38.0%), 50-79% in 111 (29.7%), and ≥ 80% in 36 (9.6%) patients. Patients with PB-FEV1 < 30% predicted had significantly more COPD exacerbations than those with PB-FEV1 30-49% predicted (p < 0.001), 50-79% predicted (p < 0.001), and ≥ 80% predicted (p = 0.002). The scores of mMRC, CAT, and SGRQ-c were not significantly higher in patients with more severe airflow limitation based on PB-FEV1 (p = 0.121-0.271). The PB-FEV1 predicted had significant weak negative correlations with exacerbations (r = - 0.182, p < 0.001), mMRC (r = - 0.121, p = 0.020), and SGRQ-c scores (r = - 0.114, p = 0.028). There was a moderate positive correlation between COPD exacerbations and scores of mMRC, CAT, and SGRQ-c (r = 0.407-0.482, all p < 0.001). There were significant strong positive correlations between mMRC score with CAT (r = 0.727) and SGRQ-c scores (r = 0.847), and CAT score with SGRQ-c score (r = 0.851) (all p < 0.001).ConclusionsIn COPD patients, different severity of airflow limitation was not associated with significant differences in the mMRC, CAT, and SGRQ-c scores. Exacerbations were significantly more frequent in patients with very severe airflow limitation only. The correlation between airflow limitation with exacerbations, mMRC, and SGRQ-c was weak.

Dataset Information

The Effect of a Post-Bronchodilator FEV₁/FVC < 0.7 on COPD Diagnosis and Treatment: A Regression Discontinuity Design.

Background

Research question

Study design and methods

Results

Interpretation

Publications

The Effect of a Post-Bronchodilator FEV<sub>1</sub>/FVC < 0.7 on COPD Diagnosis and Treatment: A Regression Discontinuity Design.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets

Dataset Information

The Effect of a Post-Bronchodilator FEV1/FVC < 0.7 on COPD Diagnosis and Treatment: A Regression Discontinuity Design.

Background

Research question

Study design and methods

Results

Interpretation

Publications

The Effect of a Post-Bronchodilator FEV&lt;sub&gt;1&lt;/sub&gt;/FVC &lt; 0.7 on COPD Diagnosis and Treatment: A Regression Discontinuity Design.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets

The Effect of a Post-Bronchodilator FEV₁/FVC < 0.7 on COPD Diagnosis and Treatment: A Regression Discontinuity Design.

The Effect of a Post-Bronchodilator FEV<sub>1</sub>/FVC < 0.7 on COPD Diagnosis and Treatment: A Regression Discontinuity Design.