Abstract
A presumed consequence of using a fixed ratio for the definition of airflow limitation (AFL) has been overdiagnosis among older and underdiagnosis among younger individuals. However, the prognosis of younger individuals with potentially underdiagnosed airflow limitation is poorly described. We hypothesised that potential underdiagnosis of AFL at younger age is associated with poor prognosis.
We assigned 95 288 participants aged 20–100 years from the Copenhagen General Population Study into: 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 of 2.7(95% CI:1.7–4.5) for pneumonias, 2.3(1.2–4.5) for heart failure, and 3.1(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
Poor prognosis in young and middle-aged adults with airflow limitation according to LLN but not fixed ratio
Footnotes
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Conflict of interest: Dr. Çolak reports personal fees from Boehringer Ingelheim and AstraZeneca outside the submitted work.
Conflict of interest: Dr. Afzal has nothing to disclose.
Conflict of interest: Dr. Nordestgaard has nothing to disclose.
Conflict of interest: Dr. Vestbo reports personal fees from GlaxoSmithKline, Chiesi pharmaceuticals, Boehringer-Ingelheim, Novartis, Almirall, AstraZeneca, personal fees from Bioxydyn, personal fees from GlaxoSmithKline, Chiesi pharmaceuticals, Novartis, AstraZeneca, Boehringer-Ingelheim, personal fees from GlaxoSmithKline, AstraZeneca, Ferring, outside the submitted work.
Conflict of interest: Dr. Lange reports grants and personal fees from Almirall, grants and personal fees from Boehringer Ingelheim, personal fees from Astra Zeneca, personal fees from Novartis, grants and personal fees from GSK, personal fees from Nycomed, personal fees from Pfizer, personal fees from Mundipharma, outside the submitted work.
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