Chest
Volume 137, Issue 6, June 2010, Pages 1345-1353
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ORIGINAL RESEARCH
COPD
Do Symptoms Predict COPD in Smokers?

https://doi.org/10.1378/chest.09-2681Get rights and content

Background

The US Preventive Services Task Force recommends against spirometry in the absence of symptoms. However, as much as 50% of COPD cases in the United States remain undiagnosed.

Methods

Report of symptoms, smoking history, and spirometric data were collected from subjects screened for a work-related medical evaluation (N = 3,955). Prevalence of airflow obstruction and respiratory symptoms were assessed. Sensitivity, specificity, positive and negative predictive values, and relative risks of predicting symptoms and smoking history for COPD were calculated.

Results

Forty-four percent of smokers in our sample had airways obstruction (AO). Of these, 36% reported a diagnosis of or treatment for COPD. Odds ratio (95% CI) for AO with smoking (≥ 20 pack-years) was 3.73 (3.12–4.45), 1.98 (1.73–2.27) for cough, 1.79 (1.55–2.08) for dyspnea, 1.95 (1.70–2.34) for sputum, and 2.59 (2.26–2.97) for wheeze. Respiratory symptoms were reported by 92% of smokers with AO, 86% smokers with restriction, 76% smokers with normal spirometry, and 73% of nonsmokers. Sensitivity (92% vs 90%), specificity (19% vs 22%), positive (47% vs 40%) and negative (75% vs 80%) predictive values for the presence of one or more symptoms were similar between smokers and all subjects.

Conclusions

COPD is underdiagnosed in the United States. Symptoms are frequent in subjects with AO and increase their risk for COPD, but add little beyond age and smoking history to the predictive value of spirometry. In view of the high prevalence of symptoms and their poor predictive value, a simpler and more effective approach would be to screen older smokers.

Section snippets

Study Population

Subjects were recruited from a cohort referred for a work-related medical evaluation from 1980 to 2008 that included a questionnaire, chest radiographs, and pulmonary function tests. The cohort originally was described in 2004.12 Referrals were drawn from trade unions and television and newspaper advertisements. Cigarette smoking was quantified by pack-years. Subjects were queried about the presence and duration of symptoms, such as cough, sputum, dyspnea on exertion, and wheeze, on most days

Study Population Demographics

Smokers with obstruction were older, smoked more, and experienced more symptoms than smokers with restrictive or normal spirometry (P < .001) (Tables 1, 2). Few smokers had a remote history of lung cancer (Fig 1). In the 1,269 subjects with obstructed spirometry, 86% were GOLD stages II to IV. BMI was significantly greater in restricted smokers compared with all other smoking groups and lower in smokers with obstruction compared with smokers with normal spirometry (P < .05) (Table 1). Only

Discussion

This study shows that AO is common in long-term smokers aged > 40 years but is infrequently recognized by health-care workers. The prevalence of symptoms is high among smokers with AO, but they are not sensitive, specific, or predictive of AO. There is a statistically significant association of both symptoms and smoking history with the presence of AO. The addition of symptoms to smoking history improves diagnostic yield marginally in a complicated statistical model but not enough to make them

Acknowledgments

Author contributions: All authors provided intellectual input to the research and manuscript. All authors contributed equally.

Dr Ohar: contributed the idea of the paper and was the primary writer.

Dr Sadeghnejad: contributed to methods and statistical analysis.

Dr Meyers: contributed to supervision of statistical analysis.

Dr Donohue: contributed to supervision of clinical methods and assessments.

Dr Bleecker: contributed to supervision of clinical methods and assessments.

Financial/nonfinancial

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    Funding/Support: The creation of the database was funded in part by the Selikoff Fund at Saint Louis University. Data analysis was funded in part by Spiromics Clinical Center [NIH HHSN 268200900019C].

    Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).

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