Clinical Validation of a Multidimensional Diagnostic Approach for COPD in Chinese Individuals.

Abstract

Although spirometry is used to diagnose COPD, a new multidimensional diagnostic schema has recently been proposed to diagnose this disease. However, evidence in Chinese individuals and those who never smoked is limited. Is the new multidimensional diagnostic method for COPD practical in the Chinese population and individuals who never smoked? We analyzed data from a 3-year, prospective, multicenter, community-based cohort study. The previous diagnostic criterion for COPD was postbronchodilator FEV₁/FVC < 0.70. The new multidimensional diagnostic schema includes the major diagnostic category (presence of the major criterion and at least 1 of 5 minor criteria) and the minor diagnostic category (presence of least 3 of 5 minor criteria). The main criterion is postbronchodilator FEV₁/FVC < 0.70. The minor criteria include emphysema, bronchial wall thickening, dyspnea, poor quality of life, and chronic bronchitis. A subgroup analysis was conducted among individuals who never smoked. Among participants without airflow obstruction, 4.8% (55 of 1,140) met the multidimensional diagnostic criteria; 5.8% (53 of 915) of participants with airflow obstruction did not meet these criteria. Participants with airflow obstruction who were excluded using the multidimensional diagnostic schema for COPD had a risk of exacerbations and annual decline in lung function similar to that in participants diagnosed as normal using both criteria. Participants without airflow obstruction reclassified as having COPD had a higher risk of exacerbations compared with those diagnosed as normal using both criteria. Similar results were found in individuals who never smoked. Our results show that the new multidimensional diagnostic schema for COPD can exclude individuals with airflow obstruction who have a favorable respiratory prognosis and identify those without airflow obstruction who are at higher risk for exacerbations in Chinese individuals and those who never smoked.