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Eur Respir J 2002; 20:1117-1122
Copyright ©ERS Journals Ltd 2002

Risk of over-diagnosis of COPD in asymptomatic elderly never-smokers

J.A. Hardie1, A.S. Buist2, W.M. Vollmer3, I. Ellingsen4, P.S. Bakke4 and O. Mørkve4

1 Institute of Internal Medicine, Deaconess Hospital, University of Bergen and 4 Dept of Thoracic Medicine, Haukeland Hospital, Bergen, Norway, 2 Division of Pulmonary and Critical Care Medicine, Oregon Health Science University and 3 Kaiser Permanente Center for Health Research, Portland, OR, USA

CORRESPONDENCE: J.A. Hardie, Institute of Internal Medicine, Deaconess Hospital, University of Bergen, Ulriksdal 8, N5009, Bergen, Norway. Fax: 47 55979435. E-mail: jon.hardie@med.uib.no

Keywords: aged, chronic obstructive pulmonary disease, spirometry

Received: March 25, 2002
Accepted June 16, 2002

This study was supported by the University of Bergen (Bergen, Norway), Nasjonalforeningen for folkehelse (Oslo, Norway) and GlaxoSmithKline (Oslo, Norway).

The Global Initiative for Chronic Obstructive Lung Disease (GOLD) has defined stage 1 chronic obstructive pulmonary disease (COPD) as forced expiratory volume in one second/forced vital capacity (FEV1/FVC)% <70% and a FEV1% predicted of >80%. Stage 2 has been defined as FEV1/FVC <70% and a FEV1% pred of <80%. The authors examined the extent of COPD misdiagnosis using this definition in healthy, never-smoker, asymptomatic adults aged >70 yrs in Bergen, Norway. A respiratory questionnaire was mailed to a random sample of 2,871 persons aged>70 yrs. In a random, well-defined subgroup of 208 never-smoker respondents with no current respiratory disease and significant dyspnoea or heart disease/hypertension complicated with dyspnoea, 71 were able to perform an acceptable spirometry. Approximately 35% of these healthy, elderly never-smokers had an FEV1/FVC% of <70% and would be classified as having at least a stage 1 COPD. This percentage increased with age and in those aged >80 yrs ~50% would be classified as having COPD and approximately one-third would have an FEV1 of <80% pred (stage 2 COPD). The estimated 5th percentile of FEV1 was consistently <80% pred.

The Global Initiative for Chronic Obstructive Lung Disease criteria will probably lead to a significant degree of over-diagnosis of chronic obstructive pulmonary disease in those aged >70 yrs. The criteria used to define the various stages of chronic obstructive pulmonary disease need to be age-specific.




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