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Lung disease test for undiagnosed millions

Wednesday January 12th 2022

A simple assessment can be used for accurate diagnosis of chronic obstructive pulmonary disease in many settings, according to a major global study.

As COPD is “significantly underdiagnosed” in low- and middle-income countries, Professor John Hurst of University College London, UK, and colleagues tested a straightforward method of diagnosis.

It takes into account the different causes of COPD in low- and middle-income countries, where it is often linked to household air pollution from cooking or heating fuel, impaired lung growth, chronic asthma and lung damage from tuberculosis.

In higher income countries, the major contributor is tobacco smoking.

The new assessment involves a questionnaire with or without Peak Expiratory Flow assessment using a low-cost device.

Its effectiveness was tested on 10,709 men and women, whose lung health was confirmed with a spirometry test, the ‘gold-standard’ measurement.

This highlighted varied rates of COPD, from 3% in Lima, Peru, to 18% in Bhaktapur, Nepal. Almost all - 95% - of cases were previously undiagnosed.

The researchers found that 49% of COPD cases were "clinically significant", and 16% "severe or very severe".

In *JAMA* yesterday, the authors explain that the screening instruments were feasible to deliver using trained research staff, taking an average of seven to eight minutes.

Professor Hurst said: “COPD is one of the world’s major public health issues, causing both individual and economic harm: there is a clear and pressing need to find better ways to identify people early, in all manner of settings.

“It is alarming that a high percentage of screen-identified COPD cases were clinically important, had severe or very severe changes in lung function, and that most were unaware of their diagnosis despite the high prevalence of symptoms and lower quality of life.

“Action is needed: the global health community has neglected the burden of chronic respiratory diseases for too long."

Siddharthan, T. et al. Discriminative accuracy of Chronic Obstructive Pulmonary Disease screening instruments in 3 low- and middle-income settings. *JAMA* 11 January 2022; doi: 10.1001/jama.2021.23065

[abstract]

Tags: Pharmaceuticals | Respiratory | UK News | World Health

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