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1 Dept of Medicine, Tufts University School of Medicine, Boston, MA, 2 Constella Health Strategies, Santa Monica, and 3 Dept of Community Health Sciences, UCLA School of Public Health, Los Angeles, CA, USA. 4 Dept of Market Access, Pricing & Outcomes Research, Boehringer Ingelheim, GmbH, Ingelheim am Rhein, Germany
CORRESPONDENCE: R.J. Halbert, 2400 Broadway, Suite 100, Santa Monica, CA 90404, USA. Fax: 1 3103157432. E-mail: rhalbert@constellagroup.com
Keywords: chronic obstructive, pulmonary disease, prevalence, spirometry, USA
Received: August 14, 2002
Accepted March 25, 2003
This study was supported by Boehringer Ingelheim, GmbH.
There is currently no consensus on the criteria for diagnosing chronic obstructive pulmonary disease. This study evaluated the impact of different definitions of airway obstruction on the estimated prevalence of obstruction in a population-based sample.
Using the Third National Health and Nutrition Examination Survey, obstructive airway disease was defined using the following criteria: 1) self-reported diagnosis of chronic bronchitis or emphysema; 2) forced expiratory volume in one second (FEV1)/forced vital capacity (FVC) <0.70 and FEV1 <80% predicted (Global Initiative for Chronic Obstructive Lung Disease (GOLD) Stage IIA); 3) FEV1/FVC below the lower limit of normal; 4) FEV1/FVC <88% pred in males and <89% pred in females; 5) FEV1/FVC <0.70 ("fixed ratio"). Spirometry in this dataset did not include reversibility testing, making it impossible to distinguish reversible from irreversible obstruction.
Rates in adults varied from 77 per 1,000 (self-report) to 168 per 1,000 (fixed ratio). For persons aged >50 yrs, the fixed ratio criteria produced the highest rate estimates. For all subgroups tested, the GOLD Stage II criteria produced lower estimates than other spirometry-based definitions.
Different definitions of obstruction may produce prevalence estimates that vary by >200%. International opinion leaders should agree upon a clear definition of chronic obstructive pulmonary disease that can serve as a population-based measurement criterion as well as a guide to clinicians.
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