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Research ArticleOriginal Research

Fixed Ratio Versus Lower Limit of Normal: Health Status and Risk Factors for COPD Overdiagnosis

Libing Ma, Ming Jiang, Jianghong Wei, Meixi Chen, Jiying Wang, Jingjie Wu, Miao Luo, Qing Xu, Xiaoli Liu, Weiwei She, Lin Mai, Shuyuan Chu and Biwen Mo
Respiratory Care November 2019, respcare.07069; DOI: https://doi.org/10.4187/respcare.07069
Libing Ma
Department of Respiratory and Critical Care Medicine, Affiliated Hospital of Guilin Medical University, Guilin, Guangxi, China.
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Ming Jiang
Department of Respiratory and Critical Care Medicine, Affiliated Hospital of Guilin Medical University, Guilin, Guangxi, China.
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Jianghong Wei
Department of Respiratory and Critical Care Medicine, Affiliated Hospital of Guilin Medical University, Guilin, Guangxi, China.
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Meixi Chen
Department of Respiratory and Critical Care Medicine, Affiliated Hospital of Guilin Medical University, Guilin, Guangxi, China.
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Jiying Wang
Department of Respiratory and Critical Care Medicine, Affiliated Hospital of Guilin Medical University, Guilin, Guangxi, China.
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Jingjie Wu
Department of Respiratory and Critical Care Medicine, Affiliated Hospital of Guilin Medical University, Guilin, Guangxi, China.
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Miao Luo
Department of Respiratory and Critical Care Medicine, Affiliated Hospital of Guilin Medical University, Guilin, Guangxi, China.
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Qing Xu
Department of Respiratory and Critical Care Medicine, Affiliated Hospital of Guilin Medical University, Guilin, Guangxi, China.
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Xiaoli Liu
Department of Respiratory and Critical Care Medicine, Affiliated Hospital of Guilin Medical University, Guilin, Guangxi, China.
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Weiwei She
Department of Respiratory and Critical Care Medicine, Affiliated Hospital of Guilin Medical University, Guilin, Guangxi, China.
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Lin Mai
Department of Respiratory and Critical Care Medicine, Affiliated Hospital of Guilin Medical University, Guilin, Guangxi, China.
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Shuyuan Chu
Department of Respiratory and Critical Care Medicine, Affiliated Hospital of Guilin Medical University, Guilin, Guangxi, China.Laboratory of Respiratory Disease, Affiliated Hospital of Guilin Medical University, Guilin, Guangxi, China.
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  • For correspondence: 1042587352@qq.com emilyyuanchu@163.com
Biwen Mo
Department of Respiratory and Critical Care Medicine, Affiliated Hospital of Guilin Medical University, Guilin, Guangxi, China.Laboratory of Respiratory Disease, Affiliated Hospital of Guilin Medical University, Guilin, Guangxi, China.Department of Respiratory Medicine, The Second Affiliated Hospital of Guilin Medical University, Guilin, Guangxi, China.
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  • For correspondence: 1042587352@qq.com emilyyuanchu@163.com
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Abstract

BACKGROUND: The threshold of the lower limit of the normal range of lung function has been suggested to be more accurate than the 0.7 fixed ratio (FEV1/FVC < 0.7) for a diagnosis of COPD. We aimed to explore the health status and risk factors of patients overdiagnosed with COPD when using the lower limit of the normal range as a diagnostic reference.

METHODS: Subjects with COPD diagnosed by a pulmonologist according to guidelines of the Global Initiative for Chronic Obstructive Lung Disease were recruited from October 2016 to April 2018. Overdiagnosed COPD was defined as FEV1/FVC that meets the criterion of the 0.7 fixed ratio but not the the lower limit of the normal range criterion. Spirometry and questionnaires were performed by eligible subjects.

RESULTS: Of the 513 subjects included in the final analysis, 20 (3.9%) were overdiagnosed when using the lower limit of the normal range as the diagnostic reference. The subjects who were overdiagnosed were older, weighed more, had better lung function, lower modified Medical British Research Council scores, and higher St. George's Respiratory Questionnaire and 36-item Short Form Survey scores than the subjects who were correctly diagnosed. Older age, heavier weight, exposure to cooking oil fumes, or a new-built or newly renovated home were associated with an increased risk of overdiagnosis of COPD (age adjusted odds ratio (OR) 1.17, 95% CI 1.09–1.26; weight adjusted OR 1.08, 95% CI 1.03–1.13; exposure to cooking oil fumes adjusted OR 3.00, 95% CI, 1.04–8.68; exposure to new-built or newly renovated home adjusted OR 10.88, 95% CI 1.46–80.87.

CONCLUSIONS: The subjects with overdiagnosed COPD had a better health status and lung function than the subjects who were correctly diagnosed. Older age, heavier weight, and exposure to cooking oil fumes or a new-built or newly renovated home were factors associated with the overdiagnosis of COPD. These findings may help reduce overdiagnosis of COPD.

  • COPD
  • overdiagnosis
  • lower limit of the normal
  • FEV1/FVC fixed ratio

Footnotes

  • Correspondence: Biwen Mo PhD, Department of Respiratory and Critical Care Medicine, Affiliated Hospital of Guilin Medical University, Lequn Road No.15, Guilin 541001, Guangxi, China. E-mail: 1042587352{at}qq.com and Shuyuan Chu PhD, Department of Respiratory and Critical Care Medicine, Affiliated Hospital of Guilin Medical University, Lequn Road No.15, Guilin 541001, Guangxi, China. E-mail: emilyyuanchu{at}163.com.
  • The authors have disclosed no conflicts of interest.

  • Copyright © 2019 by Daedalus Enterprises

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Respiratory Care: 64 (12)
Respiratory Care
Vol. 64, Issue 12
1 Dec 2019
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Fixed Ratio Versus Lower Limit of Normal: Health Status and Risk Factors for COPD Overdiagnosis
Libing Ma, Ming Jiang, Jianghong Wei, Meixi Chen, Jiying Wang, Jingjie Wu, Miao Luo, Qing Xu, Xiaoli Liu, Weiwei She, Lin Mai, Shuyuan Chu, Biwen Mo
Respiratory Care Nov 2019, respcare.07069; DOI: 10.4187/respcare.07069

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Fixed Ratio Versus Lower Limit of Normal: Health Status and Risk Factors for COPD Overdiagnosis
Libing Ma, Ming Jiang, Jianghong Wei, Meixi Chen, Jiying Wang, Jingjie Wu, Miao Luo, Qing Xu, Xiaoli Liu, Weiwei She, Lin Mai, Shuyuan Chu, Biwen Mo
Respiratory Care Nov 2019, respcare.07069; DOI: 10.4187/respcare.07069
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Keywords

  • COPD
  • overdiagnosis
  • lower limit of the normal
  • FEV1/FVC fixed ratio

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