Source: Annual Congress 2002 - Prevalence and costs of COPD
Disease area: Airway diseases

Abstract

Different definitions of airway obstruction produce prevalence estimates that can differ widely. In order to determine how this difference varies by the severity of obstruction, we used data from the Third National Health and Nutrition Examination Survey (NHANES III) to examine airway obstruction in a representative sample of US adults aged 30-75. Obstruction and severity strata were defined using the criteria of the American Thoracic Society (ATS), European Respiratory Society (ERS), and Global Initiative for Chronic Obstructive Lung Disease (GOLD). Using ATS criteria, obstruction rates per 1,000 were 98.2 (Stage I - minimal), 27.3 (Stage I – Mild), 8.8 (Stage II), and 4.5 (Stage III). For ERS criteria, rates were 234.6 per 1,000 (Mild), 44.9 (Moderate), and 14.4 (Severe). Using the GOLD criteria, rates of obstruction were 86.9 (Stage I), 59.4 (Stage IIA), 12.1 (Stage IIB), and 1.6 (Stage III). For patients with FEV1/FVC below 50% predicted, the criteria varied by less than 1 per 1,000 (ATS = 13.4, ERS = 14.4, GOLD = 13.7). For milder disease (FEV1/FVC > 50% predicted), there was over 100% variance (ATS = 125.5, ERS = 279.5, GOLD = 146.3). The GOLD and ATS criteria performed very similarly across subgroups of age, sex, race, and smoking status, while the ERS criteria consistently produced higher estimates among persons with milder obstruction, across these subgroups. Population differences between measures of obstruction primarily reflect different sensitivities in identifying persons with less severe disease.

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B. Schau, R. J. Halbert, B. R. Celli (Ingelheim, Germany; Santa Monica, Boston, United States Of America). Impact of severity on three spirometric definitions of COPD. Eur Respir J 2002; 20: Suppl. 38, 821

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