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      Characteristics of undiagnosed COPD in a senior community center

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          Abstract

          Objective

          To determine the characteristics of undiagnosed chronic obstructive pulmonary disease (COPD) in a senior community center.

          Methods

          We performed a cross-sectional, observational study with the following procedures: questionnaire to record demographic and health status data, anthropometry, questionnaire about COPD risk factors and symptoms, spirometry, and socioeconomic evaluation. Simple logistic regression and multiple analyses were carried out to assess associations. The studied variables were tested for associations with previous COPD diagnosis.

          Results

          Three hundred and thirty-five subjects aged 50 years or older were recruited and 318 completed the protocol. Seventy-one (22%) had presumptive COPD. Among them, 57 (80%) did not have a previous physician-made diagnosis of COPD. We found no associations between previous diagnosis and socioeconomic status, anthropometric data, or risk factors. Regarding respiratory symptoms, there was an association between previous COPD diagnosis and wheezing ( P=0.011). FEV 1 and FVC values were lower in the previous diagnosis group compared to the group without a previous diagnosis ( P<0.001, Student’s t-test). We found an association of lower FEV 1 (<50% predicted value) with a previous diagnosis ( P=0.028).

          Conclusion

          Our results showed a high prevalence of undiagnosed obstructive ventilatory defects in a senior community center. Previous COPD diagnosis was associated with more severe disease and more frequent wheezing. This study highlights the potential of these centers to increase COPD diagnosis and to reduce its risks.

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          Most cited references 23

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          Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. NHLBI/WHO Global Initiative for Chronic Obstructive Lung Disease (GOLD) Workshop summary.

           ,  Suzanne Hurd,  P Calverley (2001)
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            Diagnosis and management of stable chronic obstructive pulmonary disease: a clinical practice guideline update from the American College of Physicians, American College of Chest Physicians, American Thoracic Society, and European Respiratory Society.

            This guideline is an official statement of the American College of Physicians (ACP), American College of Chest Physicians (ACCP), American Thoracic Society (ATS), and European Respiratory Society (ERS). It represents an update of the 2007 ACP clinical practice guideline on diagnosis and management of stable chronic obstructive pulmonary disease (COPD) and is intended for clinicians who manage patients with COPD. This guideline addresses the value of history and physical examination for predicting airflow obstruction; the value of spirometry for screening or diagnosis of COPD; and COPD management strategies, specifically evaluation of various inhaled therapies (anticholinergics, long-acting β-agonists, and corticosteroids), pulmonary rehabilitation programs, and supplemental oxygen therapy. This guideline is based on a targeted literature update from March 2007 to December 2009 to evaluate the evidence and update the 2007 ACP clinical practice guideline on diagnosis and management of stable COPD. RECOMMENDATION 1: ACP, ACCP, ATS, and ERS recommend that spirometry should be obtained to diagnose airflow obstruction in patients with respiratory symptoms (Grade: strong recommendation, moderate-quality evidence). Spirometry should not be used to screen for airflow obstruction in individuals without respiratory symptoms (Grade: strong recommendation, moderate-quality evidence). RECOMMENDATION 2: For stable COPD patients with respiratory symptoms and FEV(1) between 60% and 80% predicted, ACP, ACCP, ATS, and ERS suggest that treatment with inhaled bronchodilators may be used (Grade: weak recommendation, low-quality evidence). RECOMMENDATION 3: For stable COPD patients with respiratory symptoms and FEV(1) 50% predicted. (Grade: weak recommendation, moderate-quality evidence). RECOMMENDATION 7: ACP, ACCP, ATS, and ERS recommend that clinicians should prescribe continuous oxygen therapy in patients with COPD who have severe resting hypoxemia (Pao(2) ≤55 mm Hg or Spo(2) ≤88%) (Grade: strong recommendation, moderate-quality evidence).
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              Developing COPD: a 25 year follow up study of the general population.

              Smokers are more prone to develop chronic obstructive pulmonary disease (COPD) than non-smokers, but this finding comes from studies spanning 10 years or less. The aim of this study was to determine the 25 year absolute risk of developing COPD in men and women from the general population. As part of the Copenhagen City Heart Study, 8045 men and women aged 30-60 years with normal lung function at baseline were followed for 25 years. Lung function measurements were collected and mortality from COPD during the 25 year observation period was analysed. The percentage of men with normal lung function ranged from 96% of never smokers to 59% of continuous smokers; for women the proportions were 91% and 69%, respectively. The 25 year incidence of moderate and severe COPD was 20.7% and 3.6%, respectively, with no apparent difference between men and women. Smoking cessation, especially early in the follow up period, decreased the risk of developing COPD substantially compared with continuous smoking. During the follow up period there were 2912 deaths, 109 of which were from COPD. 92% of the COPD deaths occurred in subjects who were current smokers at the beginning of the follow up period. The absolute risk of developing COPD among continuous smokers is at least 25%, which is larger than was previously estimated.
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                Author and article information

                Journal
                Int J Chron Obstruct Pulmon Dis
                Int J Chron Obstruct Pulmon Dis
                International Journal of COPD
                International Journal of Chronic Obstructive Pulmonary Disease
                Dove Medical Press
                1176-9106
                1178-2005
                2014
                15 October 2014
                : 9
                : 1155-1161
                Affiliations
                [1 ]Postgraduate Community Health Program, School of Medicine of Ribeirão Preto, University of São Paulo, Brazil
                [2 ]Postgraduate Community Health Program, School of Medicine of Ribeirão Preto, University of São Paulo, Brazil
                [3 ]Associate Professor, Respiratory Division, School of Medicine of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
                Author notes
                Correspondence: Elcio Oliveira Vianna, Seção de Pneumologia, Hospital das Clínicas de Ribeirão Preto. Av. Bandeirantes, Ribeirão Preto, São Paulo, Brazil, Tel +55 16 3602 2706, Fax +55 16 3602 0229, Email evianna@ 123456fmrp.usp.br
                Article
                copd-9-1155
                10.2147/COPD.S49521
                4206208
                © 2014 Santos et al. This work is published by Dove Medical Press Limited, and licensed under Creative Commons Attribution – Non Commercial (unported, v3.0) License

                The full terms of the License are available at http://creativecommons.org/licenses/by-nc/3.0/. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.

                Categories
                Original Research

                Respiratory medicine

                exercise, smoking, prevalence, senior centers, spirometry, diagnosis

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