Risk of over-diagnosis of COPD in asymptomatic elderly never-smokers

TLDR

The GOLD criteria define stage 1 COPD as FEV1/FVC < 70 % with FEV1 %pred > 80 % and stage 2 as FEV1/FVC < 70 % with FEV1 %pred < 80 %. The study assessed how the GOLD criteria misclassify healthy, never‑smoking adults over 70 and argued that COPD staging should be age‑specific. Researchers mailed a respiratory questionnaire to 2,871 adults over 70, then performed spirometry on 71 never‑smokers without respiratory disease in a randomly selected subgroup of 208 respondents. About 35 % of healthy, elderly never‑smokers met the GOLD definition of stage 1 COPD, rising to ~50 % in those over 80, indicating that the criteria will likely over‑diagnose COPD in this population.

Abstract

The Global Initiative for Chronic Obstructive Lung Disease (GOLD) has defined stage 1 chronic obstructive pulmonary disease (COPD) as forced expiratory volume in one second/forced vital capacity (FEV 1 /FVC)% &lt;70% and a FEV 1 % predicted of &gt;80%. Stage 2 has been defined as FEV 1 /FVC &lt;70% and a FEV 1 % pred of &lt;80%. The authors examined the extent of COPD misdiagnosis using this definition in healthy, never-smoker, asymptomatic adults aged &gt;70 yrs in Bergen, Norway. A respiratory questionnaire was mailed to a random sample of 2,871 persons aged&gt;70 yrs. In a random, well-defined subgroup of 208 never-smoker respondents with no current respiratory disease and significant dyspnoea or heart disease/hypertension complicated with dyspnoea, 71 were able to perform an acceptable spirometry. Approximately 35% of these healthy, elderly never-smokers had an FEV 1 /FVC% of &lt;70% and would be classified as having at least a stage 1 COPD. This percentage increased with age and in those aged &gt;80 yrs ∼50% would be classified as having COPD and approximately one-third would have an FEV 1 of &lt;80% pred (stage 2 COPD). The estimated 5th percentile of FEV 1 was consistently &lt;80% pred. The Global Initiative for Chronic Obstructive Lung Disease criteria will probably lead to a significant degree of over-diagnosis of chronic obstructive pulmonary disease in those aged &gt;70 yrs. The criteria used to define the various stages of chronic obstructive pulmonary disease need to be age-specific.