Abstract
A presumed consequence of using a fixed ratio for the definition of airflow limitation (AFL) has been overdiagnosis among older individuals and underdiagnosis among younger individuals. However, the prognosis of younger individuals with potentially underdiagnosed AFL is poorly described. We hypothesised that potential underdiagnosis of AFL at a younger age is associated with poor prognosis.
We assigned 95 288 participants aged 20–100 years from the Copenhagen General Population Study into the following groups: individuals without AFL with forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC) ≥0.70 and ≥lower limit of normal (LLN) (n=78 779, 83%); individuals with potentially underdiagnosed AFL with FEV1/FVC ≥0.70 and <LLN (n=1056, 1%); individuals with potentially overdiagnosed AFL with FEV1/FVC <0.70 and ≥LLN (n=3088, 3%); and individuals with AFL with FEV1/FVC <0.70 and <LLN (n=12 365, 13%). We assessed risk of exacerbations, pneumonias, ischaemic heart disease, heart failure and all-cause mortality. Median follow-up was 6.0 years (range: 2 days–11 years).
Compared to individuals without AFL, individuals with potentially underdiagnosed AFL had an increased risk of morbidity and mortality with age- and sex-adjusted hazard ratios (HR) of 2.7 (95% CI: 1.7–4.5) for pneumonias, 2.3 (95% CI: 1.2–4.5) for heart failure, and 3.1 (95% CI: 2.1–4.6) for all-cause mortality.
Young and middle-aged adults with AFL according to LLN but not fixed ratio experience increased respiratory and cardiovascular morbidity and early death.
Abstract
Young and middle-aged adults with airflow limitation according to LLN but not fixed ratio have poor prognosis http://ow.ly/QwOP30iiU11
Footnotes
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Conflict of interest: Y. Çolak has received personal fees from Boehringer Ingelheim and AstraZeneca outside the submitted work. J. Vestbo has received personal fees for consultancy for COPD phase 2 and 3 programmes from GlaxoSmithKline, Chiesi pharmaceuticals, Boehringer-Ingelheim, Novartis, Almirall and AstraZeneca, personal fees for consultancy for MRI software development from Bioxydyn, personal fees for lectures including service in speakers bureaus from GlaxoSmithKline, Chiesi pharmaceuticals, Novartis, AstraZeneca and Boehringer-Ingelheim, and personal fees from GlaxoSmithKline, AstraZeneca, Ferring, outside the submitted work. P. Lange has received grants and personal fees from Almirall, Boehringer Ingelheim and GSK, and personal fees from Astra Zeneca, Novartis, Nycomed, Pfizer and Mundipharma, outside the submitted work.
Support statement: The Lundbeck Foundation and the Danish Lung Association supported this work. The funders had no role in the design and conduct of the study, the collection, management, analysis or interpretation of the data, the preparation, review or approval of the manuscript, or the decision to submit the manuscript for publication. Funding information for this article has been deposited with the Crossref Funder Registry.
Author contributions: Y. Çolak and P. Lange had full access to all of the data in the study and had final responsibility for the decision to submit for publication. Y. Çolak, S. Afzal, B.G. Nordestgaard, J. Vestbo and P. Lange contributed to the study concept and design. Y. Çolak, S. Afzal, B.G. Nordestgaard, J. Vestbo and P. Lange collected, analysed or interpreted the data. Y. Çolak wrote the draft manuscript. Y. Çolak, S. Afzal, B.G. Nordestgaard, J. Vestbo and P. Lange revised the manuscript for important intellectual content. Y. Çolak performed the statistical analyses. B.G. Nordestgaard and P. Lange obtained the funding. B.G. Nordestgaard provided administrative, technical or material support. P. Lange supervised the study.
- Received December 22, 2017.
- Accepted February 4, 2018.
- Copyright ©ERS 2018