Chronic Obstructive Pulmonary Disease Overdiagnosis and Overtreatment: A Meta-Analysis

Chronic obstructive pulmonary disease across three decades: trends, inequalities, and projections from the Global Burden of Disease Study 2021

Objective

To assess the global burden of chronic obstructive pulmonary disease (COPD) and cross-country inequalities from 1990 to 2021 and project changes until 2045.

Methods

Data on prevalence, mortality, and disability-adjusted life-years (DALYs) for COPD were extracted from the Global Burden of Disease Study 2021 (https://vizhub.healthdata.org/gbd-results/). Trends were analyzed globally, regionally, and nationally, considering population growth, aging, and epidemiological changes. Inequalities were quantified using the World Health Organization's health equity framework. Future projections were estimated to 2045.

Results

From 1990 to 2021, global age-standardized rates of COPD prevalence, mortality, and DALYs declined annually by -0.04, -1.75%, and -1.71%, respectively. However, absolute cases, deaths, and DALYs increased by 112.23, 49.06, and 40.23%, driven by population growth and aging. Men consistently showed higher age-standardized rates. East Asia reported the highest absolute cases and deaths, while South Asia had the largest DALYs. High-income North America and Oceania had the highest age-standardized rates, while Australasia and Eastern Europe saw the steepest declines in prevalence and mortality, respectively. Disparities in COPD burden across sociodemographic index levels widened over time. By 2045, absolute numbers of COPD cases, deaths, and DALYs are projected to rise despite declining age-standardized rates.

Conclusion

While global age-standardized rates of COPD prevalence, mortality, and DALYs have declined, the absolute burden has increased due to demographic shifts. Persistent disparities in COPD burden, particularly in low- and middle-sociodemographic index regions, underscore the need for targeted prevention and management strategies.

Development and Validation of a Quantitative Score for the Criteria Clinical Control in Stable COPD Proposed in the Spanish COPD Guidelines (GesEPOC): Results of the EPOCONSUL Audit

Introduction/Objective: the concept of clinical control of COPD is a measure proposed in the Spanish COPD Guidelines (GesEPOC), which aims to help clinicians assess the clinical status in order to adapt the treatment plan at follow-up. However, studies that have evaluated clinical practice reveal that the degree of control of COPD is not always assessed, which underlines the need to promote its assessment through a scoring system. To develop a scoring system that quantitatively assesses the validated criteria defining the degree of COPD control. Methods: this study used data from the EPOCONSUL audit in respiratory clinics across Spain. We included in this analysis all patients with a COPD clinical control grade estimated and reported by the physician at the visit, who had registered the criteria necessary to define the degree of clinical control validated and established in GesEPOC. Patients were randomly assigned to either the development or validation cohorts. The development cohort included 485 patients and the validation cohort included 341 patients. Score modelling was conducted using a multivariate logistic regression model, and calibration of the model and score was assessed using the Hosmer-Lemeshow goodness-of-fit test and GiViTi Calibration belts. The model and generated score's discrimination capacity were analyzed by calculating the Area Under the Curve (AUC). Results: the scoring system was developed using four criteria as predictors of poor clinical control of COPD reported by the treating physician:adjusted dyspnoea severity, use of rescue inhaler more than three times per week, walking less than 30 min per day, and COPD exacerbations in the last three months. The scoring system attributed scores from 0 to 8. Calibration was satisfactory in both development and validation cohorts, and the score's discrimination power, as indicated by the AUC, was 0.892. Conclusions: this scoring system provides an easy-to-use quantitative assessment of clinical control of COPD that we believe will help to measure COPD control and its evolution during patient follow-up. Future research will be needed to prospectively evaluate this score as a predictor of outcome.

Is Type and Grade of Emphysema Important for Bone Mineral Density and Aortic Calcifications?

Background: Chronic obstructive pulmonary disease has extrapulmonary manifestations, such as cardiovascular diseases and osteoporosis. The purpose of this research was to determine the relationship between the type and extent of emphysema with thoracic aorta calcification (TAC) and bone mineral density (BMD) at Th4, Th8, and L1 vertebrae. Methods: Emphysema was described by computed tomography parameters (both Fleischner classification and low attenuation value percentage, LAV%) and the clinical FEV1/FVC ratio (Tiffeneau-Pinelli index, TI, TI < 0.7; TI > 0.7). Results: Of 200 included patients (median age 64, 33% women), signs of clinical obstruction (TI) were observed in 104 patients, which had significantly lower BMD and more heavy TAC. BMD correlated negatively with LAV%, Rho = -0.16 to -0.23, while a positive correlation of aortic calcification with LAV% was observed, Rho = 0.30 to 0.33. Multiple linear regression showed that age and TI < 0.7 were independent predictors of BMD, β = -0.20 to -0.40, and β = -0.21 to -0.25; age and hypercholesterolemia were independent predictors of TCA, β = 0.61 and β = 0.19. Conclusions: Clinical TI and morphological LAV% parameters correlated with BMD and TAC, in contrast to Fleischer-graded emphysema, which showed no correlation. However, only TI was an independent predictor of BMD, while the morphologically described type and extent of emphysema could not independently predict any extrapulmonary manifestation.

Association between chronic obstructive pulmonary disease and in-hospital mortality after percutaneous coronary intervention: a retrospective cohort study in Germany

Chronic obstructive pulmonary disease (COPD) is one of the leading chronic diseases worldwide. However, the impact of COPD on outcome after percutaneous coronary intervention (PCI) remains unclear. In this retrospective cohort study, we analyzed the data of hospitalized patients undergoing PCI in Germany between 2015 and 2019. We compared in-hospital mortality, hospital length of stay and peri-interventional ventilation time (VT) in patients with and without COPD, including different COPD severity grades, COPD with exacerbation (COPDe) and infection (COPDi). We analyzed the data of 3,464,369 cases undergoing PCI. A total of 291,707 patients (8.4%) suffered from COPD. Patients suffering from COPD died more often (2.4% vs. 2.0%; p < 0.001), stayed longer hospitalized (5 days (2-10) vs. 3 days (1-6); p < 0.001), were more frequent (7.2% vs. 3.2%) and longer ventilated (26 h (7-88) vs. 23 h (5-92); p < 0.001). Surprisingly, COPD was associated with a 0.78-fold odds of in-hospital mortality and with reduced VT (- 1.94 h, 95% CI, - 4.34 to 0.43). Mild to severe COPD was associated with a lower risk of in-hospital mortality and reduced VT, whereas very severe COPD, COPDe and COPDi showed a higher risk of in-hospital mortality. We found a paradoxical association between mild to severe COPD and in-hospital mortality, whereas very severe COPD, COPDe and COPDi were associated with higher in-hospital mortality. Further investigations should illuminate, whether comorbidities affect these associations.