Estimating prevalence of chronic obstructive pulmonary disease in the Southern Cone of Latin America: how different spirometric criteria may affect disease burden and health policies

Edgardo Sobrino, Vilma E Irazola, Laura Gutierrez, Chung-Shiuan Chen, Fernando Lanas, Matías Calandrelli, Jacqueline Ponzo, Nora Mores, Pamela Serón, Allison Lee, Jiang He, Adolfo L Rubinstein, Edgardo Sobrino, Vilma E Irazola, Laura Gutierrez, Chung-Shiuan Chen, Fernando Lanas, Matías Calandrelli, Jacqueline Ponzo, Nora Mores, Pamela Serón, Allison Lee, Jiang He, Adolfo L Rubinstein

Abstract

Background: Chronic obstructive pulmonary disease (COPD) is the fourth leading cause of death worldwide. The study aimed to determine and compare the prevalence of COPD in the general population aged 45-74 years old according to fixed ratio and lower limit of normal (LLN) thresholds in four cities in the Southern Cone of Latin America.

Methods: The Pulmonary Risk in South America (PRISA) study used a 4-stage stratified sampling method to select 5814 participants from 4 cities in the Southern Cone of Latin America (Bariloche and Marcos Paz, Argentina; Temuco, Chile; and Pando-Barros Blancos, Uruguay). Data on demographic information, medical history, risk factors, pre-bronchodilator and post-bronchodilator spirometry were obtained using a standard protocol. According to GOLD, COPD was defined as a post-bronchodilator ratio of forced expiratory volume in one second (FEV1) over forced vital capacity (FVC) less than 70%. The LLN threshold was defined as the lower fifth percentile for predicted FEV1/FVC, and was evaluated as an alternative COPD definition.

Results: Overall COPD prevalence was 9.3% (95% CI 8.4, 10.2%), and men had a higher prevalence [11.8% (95% CI 10.3, 13.3%)] than women [7.3% (95% CI 6.2, 8.3%)] with the fixed ratio. Overall COPD prevalence using LLN was 4.7% (95% CI 4.1, 5.3%), higher in men: 5.8% (95% CI 4.7, 6.8%) than women: 3.9% (95% CI 3.1, 4.7%). COPD prevalence was significantly higher among those who were older, had <high-school education and lower body-mass index, were cigarette smokers, and had self-reported history of asthma and tuberculosis.

Conclusions: First, COPD and its risk factors are highly prevalent in the general population of Argentina, Chile, and Uruguay. Second, the prevalence of COPD by LLN criterion was significantly lower with lesser degrees of severity compared to fixed ratio of FEV1/FVC. Implementing LLN criterion instead of fixed ratio of FEV1/FVC may reduce the risk of over-diagnosis of COPD, although further prognostic studies of COPD adverse outcomes should be conducted using both definitions. Third, these data suggest that national efforts on the prevention, treatment, and control of COPD should be a public health priority in the Southern Cone of Latin America.

Keywords: Chronic obstructive pulmonary disease; Cross sectional study; Fixed ratio; Lower limit normal; Prevalence; Risk factors; South America.

Conflict of interest statement

Ethics approval and consent to participate

The study protocol has been approved by IRBs in all participating institutes in Argentina (Comité de Ética de Protocolos de Investigación del Hospital Italiano de Buenos Aires), Chile (Comité de Ética del Servicio de Salud Araucanía Sur, Universidad de la Frontera), Uruguay (Comité de Ética para Proyectos de Investigación de la Universidad de la República) and US (Tulane University Biomedical IRB). The written informed consent has been obtained from all study participants.

Consent for publication

Not applicable.

Competing interests

All the authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Flowchart showing study participants

References

    1. Lozano R, Naghavi M, Foreman K, Lim S, Shibuya K, Aboyans V, Abraham J, Adair T, Aggarwal R, Ahn SY, Alvarado M, Anderson HR, Anderson LM, Andrews KG, Atkinson C, Baddour LM, Barker-Collo S, Bartels DH, Bell ML, Benjamin EJ, Bennett D, Bhalla K, Bikbov B, Bin Abdulhak A, Birbeck G, Blyth F, Bolliger I, Boufous S, Bucello C, Burch M, Burney P, Carapetis J, Chen H, Chou D, Chugh SS, Coffeng LE, Colan SD, Colquhoun S, Colson KE, Condon J, Connor MD, Cooper LT, Corriere M, Cortinovis M, de Vaccaro KC, Couser W, Cowie BC, Criqui MH, Cross M, Dabhadkar KC, Dahodwala N, De Leo D, Degenhardt L, Delossantos A, Denenberg J, Des Jarlais DC, Dharmaratne SD, Dorsey ER, Driscoll T, Duber H, Ebel B, Erwin PJ, Espindola P, Ezzati M, Feigin V, Flaxman AD, Forouzanfar MH, Fowkes FG, Franklin R, Fransen M, Freeman MK, Gabriel SE, Gakidou E, Gaspari F, Gillum RF, Gonzalez-Medina D, Halasa YA, Haring D, Harrison JE, Havmoeller R, Hay RJ, Hoen B, Hotez PJ, Hoy D, Jacobsen KH, James SL, Jasrasaria R, Jayaraman S, Johns N, Karthikeyan G, Kassebaum N, Keren A, Khoo JP, Knowlton LM, Kobusingye O, Koranteng A, Krishnamurthi R, Lipnick M, Lipshultz SE, Ohno SL, Mabweijano J, MF MI, Mallinger L, March L, Marks GB, Marks R, Matsumori A, Matzopoulos R, Mayosi BM, JH MA, MM MD, McGrath J, Mensah GA, Merriman TR, Michaud C, Miller M, Miller TR, Mock C, Mocumbi AO, Mokdad AA, Moran A, Mulholland K, Nair MN, Naldi L, Narayan KM, Nasseri K, Norman P, O'Donnell M, Omer SB, Ortblad K, Osborne R, Ozgediz D, Pahari B, Pandian JD, Rivero AP, Padilla RP, Perez-Ruiz F, Perico N, Phillips D, Pierce K, Pope CA, 3rd, Porrini E, Pourmalek F, Raju M, Ranganathan D, Rehm JT, Rein DB, Remuzzi G, Rivara FP, Roberts T, De León FR, Rosenfeld LC, Rushton L, Sacco RL, Salomon JA, Sampson U, Sanman E, Schwebel DC, Segui-Gomez M, Shepard DS, Singh D, Singleton J, Sliwa K, Smith E, Steer A, Taylor JA, Thomas B, Tleyjeh IM, Towbin JA, Truelsen T, Undurraga EA, Venketasubramanian N, Vijayakumar L, Vos T, Wagner GR, Wang M, Wang W, Watt K, Weinstock MA, Weintraub R, Wilkinson JD, Woolf AD, Wulf S, Yeh PH, Yip P, Zabetian A, Zheng ZJ, Lopez AD, Murray CJ, MA AM, Memish ZA. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the global burden of disease study 2010. Lancet. 2012;380:2095–2128. doi: 10.1016/S0140-6736(12)61728-0.
    1. GBD 2013 Mortality and Causes of Death Collaborators Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990-2013: a systematic analysis for the global burden of disease study 2013. Lancet. 2015;385:117–171. doi: 10.1016/S0140-6736(14)61682-2.
    1. Casas Herrera A, Montes de Oca M, López Varela MV, Aguirre C, Schiavi E, Jardim JR, PUMA Team. COPD Underdiagnosis and misdiagnosis in a high-risk primary care population in four Latin American countries. A key to enhance disease diagnosis: the PUMA study. PLoS One. 2016;11(4) doi: 10.1371/journal.pcbi.1004820.
    1. Caballero A, Torres-Duque CA, Jaramillo C, Bolívar F, Sanabria F, Osorio P, Orduz C, Guevara DP, Maldonado D. Prevalence of COPD in five Colombian cities situated at low, medium, and high altitude (PREPOCOL study) Chest. 2008;133:343–349. doi: 10.1378/chest.07-1361.
    1. Menezes AM, Perez-Padilla R, Jardim JR, Muiño A, Lopez MV, Valdivia G, Montes de Oca M, Talamo C, Hallal PC, Victora CG. Chronic obstructive pulmonary disease in five Latin American cities (the PLATINO study): a prevalence study. Lancet. 2005;366:1875–1881. doi: 10.1016/S0140-6736(05)67632-5.
    1. Menezes A, Macedo SC, Gigante DP, da Costa JD, Olinto MT, Fiss E, Chatkin M, Hallal PC, Victora CG. Prevalence and risk factors for chronic obstructive pulmonary disease according to symptoms and spirometry. COPD. 2004;1:173–117. doi: 10.1081/COPD-120039561.
    1. Jaganath D, Jaime Miranda J, Gilman RH, Wise RA, Diett GB, Miele CH, Bernabe-Ortiz A, Checkley W, CRONICAS Cohort Study Group Prevalence of chronic obstructive pulmonary disease and variation in risk factors across four geographically diverse resource-limited settings in Peru. Respir Res. 2015;16:40. doi: 10.1186/s12931-015-0198-2.
    1. Lamprecht B, Soriano JB, Studnicka M, Kaiser B, Vanfleteren LE, Gnatiuc L, Burney P, Miravitlles M, García-Rio F, Akbari K, Ancochea J, Menezes AM, Perez-Padilla R, Montes de Oca M, Torres-Duque CA, Caballero A, González-García M, Buist S, BOLD Collaborative Research Group, the EPI-SCAN Team, the PLATINO Team, and the PREPOCOL Study Group BOLD Collaborative Research Group the EPI-SCAN Team the PLATINO Team and the PREPOCOL Study Group. Chest. 2015;148(4):971–985. doi: 10.1378/chest.14-2535.
    1. Hill K, Goldstein RS, Guyatt GH, Blouin M, Tan WC, Davis LL, et al. Prevalence and underdiagnosis of chronic obstructive pulmonary disease among patients at risk in primary care. CMAJ. 2010;182:673–678. doi: 10.1503/cmaj.091784.
    1. Rubinstein AL, Irazola VE, Bazzano LA, Sobrino E, Calandrelli M, Lanas F, Lee AG, Manfredi JA, Olivera H, Ponzo J, Seron P, He J. Detection and follow-up of chronic obstructive pulmonary disease (COPD) and risk factors in the Southern Cone of Latin America. The pulmonary risk in South America (PRISA) study. BMC Pulmonary Medicine. 2011;11:34. doi: 10.1186/1471-2466-11-34.
    1. World Health Organization. GATS (global adult tobacco survey). Available: . Accessed on April 10, 2015.
    1. Centers for Disease Control and Prevention (CDC). Cigarette smoking among adults-United States, 2006. MMWR Morb Mortal Wkly Rep. 2007;56:1157–1161.
    1. Yin P, Jiang CQ, Cheng KK, Lam TH, Lam KH, Miller MR, Zhang WS, Thomas GN, Adab P. Passive smoking exposure and risk of COPD among adults in China: the Guangzhou biobank cohort study. Lancet. 2007;370:751–757. doi: 10.1016/S0140-6736(07)61378-6.
    1. Perez-Padilla R, Fernandez R, Lopez Varela MV, Montes de Oca M, Muiño A, Tálamo C, Brito Jardim JR, Valdivia G, Baptista Menezes AM. Airflow obstruction in never smokers in five Latin American cities: the PLATINO study. Arch Med Res. 2012;43:159–165. doi: 10.1016/j.arcmed.2012.03.007.
    1. Perez-Padilla R, Regalado J, Sverre V, Pare P, Chapela R, Sansores R, Selman M. Exposure to biomass smoke and chronic airway disease in Mexican woman: a case-control study. Am J Respir Crit Care Med. 1996;154:701–706. doi: 10.1164/ajrccm.154.3.8810608.
    1. Ramírez-Venegas A, Sansores RH, Pérez-Padilla R, Regalado J, Velázquez A, Sánchez C, Mayar ME. Survival of patients with chronic obstructive pulmonary disease due to biomass smoke and tobacco. Am J Respir. Crit Care Med. 2006;173:393–397. doi: 10.1164/rccm.200504-568OC.
    1. Pérez-Padilla R, Vázquez-García JC, Márquez MN, Jardim JR, Pertuzé J, Lisboa C, Muiño A, López MV, Tálamo C, de Oca MM, Valdivia G, Menezes AM, Latin American COPD Prevalence Study (PLATINO) Team The long-term stability of portable spirometers used in a multinational study of the prevalence of chronic obstructive pulmonary disease. Respir Care. 2006;51:1167–1171.
    1. Miller MR, Hankinson J, Brusasco V, Burgos F, Casaburi R, Coates A, Crapo R, Enright P, van der Grinten CP, Gustafsson P, Jensen R, Johnson DC, MacIntyre N, McKay R, Navajas D, Pedersen OF, Pellegrino R, Viegi G, Wanger J. ATS/ERS task force. Standardisation of spirometry. Eur Respir J. 2005;26:319–338. doi: 10.1183/09031936.05.00034805.
    1. Vestbo J, Hurd SS, Agustí AG, Jones PW, Vogelmeier C, Anzueto A, Barnes PJ, Fabbri LM, Martinez FJ, Nishimura M, Stockley RA, Sin DD, Rodriguez-Roisin R. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary. Am J Respir Crit Care Med. 2013;187:347–365. doi: 10.1164/rccm.201204-0596PP.
    1. Perez-Padilla R, Valdivia G, Muiño A, et al. Valores de referencia espirométrica en 5 grandes ciudades de Latinoamérica para sujetos de 40 o más años de edad. Arch Bronconeumol. 2006;42:317–325. doi: 10.1157/13090581.
    1. Plan and operation of the Third National Heaith and Nutrition Examination Survey, 1988-94. National Center for Heaith Statistics. Vial Health Stat 1(32). 1994.
    1. Ciapponi A, Alison L, Agustina M, Demián G, Silvana C, Edgardo S. The epidemiology and burden of COPD in Latin America and the Caribbean: systematic review and meta-analysis. COPD. 2014;11:339–350.
    1. Swanney MP, Ruppel G, Enright PL, et al. Using the lower limit of normal for the FEV1/FVC 1ratio reduces the misclassification of airway obstruction. Thorax. 2008;63:1046–1051. doi: 10.1136/thx.2008.098483.
    1. Güder G, Brenner S, Angermann CE, Ertl G, Held M, Sachs AP, Lammers JW, Zanen P, Hoes AW, Störk S, Rutten FH. GOLD or lower limit of normal definition? A comparison with expert-based diagnosis of chronic obstructive pulmonary disease in a prospective cohort-study. Respir Res. 2012;13:13. doi: 10.1186/1465-9921-13-13.
    1. Van Dijk WD, Gupta N, Tan WC. Bourbeau Clinical relevance of diagnosing COPD by fixed ratio or lower limit of normal: a systematic review. J COPD. 2014;11(1):113–120. doi: 10.3109/15412555.2013.781996.
    1. Van Dijk W, Tan W, Li P, Guo B, Li S, Benedetti A, Bourbeau J, CanCOLD Study Group Clinical relevance of fixed ratio vs lower limit of normal of FEV1/FVC in COPD: patient-reported outcomes from the CanCOLD cohort. Ann Fam Med. 2015;13(1):41–48. doi: 10.1370/afm.1714.
    1. Miller MR, Levy ML. Chronic obstructive pulmonary disease: missed diagnosis versus misdiagnosis. BMJ. 2015;1:351.
    1. Barreto SM, Miranda JJ, Figueroa JP, Schmidt MI, Munoz S, Kuri-Morales PP, Silva JB., Jr Epidemiology in Latin America and the Caribbean: current situation and challenges. Int J Epidemiol. 2012;41(2):557–571. doi: 10.1093/ije/dys017.
    1. Montes de Oca M, Tálamo C, Perez-Padilla R, Jardim JR, Muiño A, Lopez MV, Valdivia G, Pertuzé J, Moreno D, Halbert RJ, Menezes AM. PLATINO Team Chronic obstructive pulmonary disease and body mass index in five Latin America cities: the PLATINO study Respir Med. 2008;102:642–650.
    1. Harik-Khan RI, Fleg JL, Wise RA. Body mass index and the risk of COPD. Chest. 2002;121:370–376. doi: 10.1378/chest.121.2.370.
    1. Landbo C, Prescott E, Lange P, Vestbo J, Almdal TP. Prognostic value of nutritional status in chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 1999;160:1856–1861. doi: 10.1164/ajrccm.160.6.9902115.
    1. Prescott E, Vestbo J. Socioeconomic status and chronic obstructive pulmonary disease. Thorax. 1999;54:737–741. doi: 10.1136/thx.54.8.737.
    1. Lange P, Marott JL, Vestbo J, Ingebrigtsen TS, Nordestgaard BG. Socioeconomic status and prognosis of COPD in Denmark. COPD. 2014;11:431–437. doi: 10.3109/15412555.2013.869580.
    1. Vignola AM, Kips J, Bousquet J. Tissue remodeling as a feature of persistent asthma. J Allergy Clin Immunol. 2000;105(pt 1):1041–1053. doi: 10.1067/mai.2000.107195.
    1. Silva GE, Sherrill DL, Guerra S, Barbee RA. Asthma as a risk factor for COPD in a longitudinal study. Chest. 2004;126:59–65. doi: 10.1378/chest.126.1.59.
    1. Snider GL, Doctor L, Demas TA, Shaw AR. Obstructive airway disease in patients with treated pulmonary tuberculosis. Am Rev Respir Dis. 1971;103:625–640.
    1. Menezes AM, Hallal PC, Perez-Padilla R, Jardim JR, Muiño A, Lopez MV, et al. Tuberculosis and airflow obstruction: evidence from the PLATINO study in Latin America. Eur Respir J. 2007;30:1180–1185. doi: 10.1183/09031936.00083507.
    1. William Torres-Duque C, Maldonado D, Pérez-Padilla R, Ezzati M, Viegi G. Forum of international respiratory studies (FIRS) task force on health effects of biomass exposure. Biomass fuels and respiratory diseases Proc Am Thorac Soc. 2008;5:577–590. doi: 10.1513/pats.200707-100RP.
    1. Kurmi OP, Semple S, Simkhada P, Smith WC, Ayres J. COPD and chronic bronchitis risk of indoor air pollution from solid fuel: a systematic review and meta-analysis. Thorax. 2010;65:221–228. doi: 10.1136/thx.2009.124644.
    1. Vanfleteren LE, Spruit MA, Groenen M, et al. Clusters of comorbidities based on validated objective measurements and systemic inflammation in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2013;187:728–735. doi: 10.1164/rccm.201209-1665OC.
    1. Woodruff PG, Barr RG, Bleecker E, et al. Clinical significance of symptoms in smokers with preserved pulmonary function. N Engl J Med. 2016;374:1811–1821. doi: 10.1056/NEJMoa1505971.

Source: PubMed

赞助者和合作者

医疗条件

药物干预

3
订阅