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Ten-year prediction model for post-bronchodilator airflow obstruction and early detection of COPD: development and validation in two middle-aged population-based cohorts

BACKGROUND: Classifying individuals at high chronic obstructive pulmonary disease (COPD)-risk creates opportunities for early COPD detection and active intervention. OBJECTIVE: To develop and validate a statistical model to predict 10-year probabilities of COPD defined by post-bronchodilator airflow...

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Autores principales: Perret, Jennifer L, Vicendese, Don, Simons, Koen, Jarvis, Debbie L, Lowe, Adrian J, Lodge, Caroline J, Bui, Dinh S, Tan, Daniel, Burgess, John A, Erbas, Bircan, Bickerstaffe, Adrian, Hancock, Kerry, Thompson, Bruce R, Hamilton, Garun S, Adams, Robert, Benke, Geza P, Thomas, Paul S, Frith, Peter, McDonald, Christine F, Blakely, Tony, Abramson, Michael J, Walters, E Haydn, Minelli, Cosetta, Dharmage, Shyamali C
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8640628/
https://www.ncbi.nlm.nih.gov/pubmed/34857526
http://dx.doi.org/10.1136/bmjresp-2021-001138
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author Perret, Jennifer L
Vicendese, Don
Simons, Koen
Jarvis, Debbie L
Lowe, Adrian J
Lodge, Caroline J
Bui, Dinh S
Tan, Daniel
Burgess, John A
Erbas, Bircan
Bickerstaffe, Adrian
Hancock, Kerry
Thompson, Bruce R
Hamilton, Garun S
Adams, Robert
Benke, Geza P
Thomas, Paul S
Frith, Peter
McDonald, Christine F
Blakely, Tony
Abramson, Michael J
Walters, E Haydn
Minelli, Cosetta
Dharmage, Shyamali C
author_facet Perret, Jennifer L
Vicendese, Don
Simons, Koen
Jarvis, Debbie L
Lowe, Adrian J
Lodge, Caroline J
Bui, Dinh S
Tan, Daniel
Burgess, John A
Erbas, Bircan
Bickerstaffe, Adrian
Hancock, Kerry
Thompson, Bruce R
Hamilton, Garun S
Adams, Robert
Benke, Geza P
Thomas, Paul S
Frith, Peter
McDonald, Christine F
Blakely, Tony
Abramson, Michael J
Walters, E Haydn
Minelli, Cosetta
Dharmage, Shyamali C
author_sort Perret, Jennifer L
collection PubMed
description BACKGROUND: Classifying individuals at high chronic obstructive pulmonary disease (COPD)-risk creates opportunities for early COPD detection and active intervention. OBJECTIVE: To develop and validate a statistical model to predict 10-year probabilities of COPD defined by post-bronchodilator airflow obstruction (post-BD-AO; forced expiratory volume in 1 s/forced vital capacity<5th percentile). SETTING: General Caucasian populations from Australia and Europe, 10 and 27 centres, respectively. PARTICIPANTS: For the development cohort, questionnaire data on respiratory symptoms, smoking, asthma, occupation and participant sex were from the Tasmanian Longitudinal Health Study (TAHS) participants at age 41–45 years (n=5729) who did not have self-reported COPD/emphysema at baseline but had post-BD spirometry and smoking status at age 51–55 years (n=2407). The validation cohort comprised participants from the European Community Respiratory Health Survey (ECRHS) II and III (n=5970), restricted to those of age 40–49 and 50–59 with complete questionnaire and spirometry/smoking data, respectively (n=1407). STATISTICAL METHOD: Risk-prediction models were developed using randomForest then externally validated. RESULTS: Area under the receiver operating characteristic curve (AUC(ROC)) of the final model was 80.8% (95% CI 80.0% to 81.6%), sensitivity 80.3% (77.7% to 82.9%), specificity 69.1% (68.7% to 69.5%), positive predictive value (PPV) 11.1% (10.3% to 11.9%) and negative predictive value (NPV) 98.7% (98.5% to 98.9%). The external validation was fair (AUC(ROC) 75.6%), with the PPV increasing to 17.9% and NPV still 97.5% for adults aged 40–49 years with ≥1 respiratory symptom. To illustrate the model output using hypothetical case scenarios, a 43-year-old female unskilled worker who smoked 20 cigarettes/day for 30 years had a 27% predicted probability for post-BD-AO at age 53 if she continued to smoke. The predicted risk was 42% if she had coexistent active asthma, but only 4.5% if she had quit after age 43. CONCLUSION: This novel and validated risk-prediction model could identify adults aged in their 40s at high 10-year COPD-risk in the general population with potential to facilitate active monitoring/intervention in predicted ‘COPD cases’ at a much earlier age.
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spelling pubmed-86406282021-12-15 Ten-year prediction model for post-bronchodilator airflow obstruction and early detection of COPD: development and validation in two middle-aged population-based cohorts Perret, Jennifer L Vicendese, Don Simons, Koen Jarvis, Debbie L Lowe, Adrian J Lodge, Caroline J Bui, Dinh S Tan, Daniel Burgess, John A Erbas, Bircan Bickerstaffe, Adrian Hancock, Kerry Thompson, Bruce R Hamilton, Garun S Adams, Robert Benke, Geza P Thomas, Paul S Frith, Peter McDonald, Christine F Blakely, Tony Abramson, Michael J Walters, E Haydn Minelli, Cosetta Dharmage, Shyamali C BMJ Open Respir Res Respiratory Epidemiology BACKGROUND: Classifying individuals at high chronic obstructive pulmonary disease (COPD)-risk creates opportunities for early COPD detection and active intervention. OBJECTIVE: To develop and validate a statistical model to predict 10-year probabilities of COPD defined by post-bronchodilator airflow obstruction (post-BD-AO; forced expiratory volume in 1 s/forced vital capacity<5th percentile). SETTING: General Caucasian populations from Australia and Europe, 10 and 27 centres, respectively. PARTICIPANTS: For the development cohort, questionnaire data on respiratory symptoms, smoking, asthma, occupation and participant sex were from the Tasmanian Longitudinal Health Study (TAHS) participants at age 41–45 years (n=5729) who did not have self-reported COPD/emphysema at baseline but had post-BD spirometry and smoking status at age 51–55 years (n=2407). The validation cohort comprised participants from the European Community Respiratory Health Survey (ECRHS) II and III (n=5970), restricted to those of age 40–49 and 50–59 with complete questionnaire and spirometry/smoking data, respectively (n=1407). STATISTICAL METHOD: Risk-prediction models were developed using randomForest then externally validated. RESULTS: Area under the receiver operating characteristic curve (AUC(ROC)) of the final model was 80.8% (95% CI 80.0% to 81.6%), sensitivity 80.3% (77.7% to 82.9%), specificity 69.1% (68.7% to 69.5%), positive predictive value (PPV) 11.1% (10.3% to 11.9%) and negative predictive value (NPV) 98.7% (98.5% to 98.9%). The external validation was fair (AUC(ROC) 75.6%), with the PPV increasing to 17.9% and NPV still 97.5% for adults aged 40–49 years with ≥1 respiratory symptom. To illustrate the model output using hypothetical case scenarios, a 43-year-old female unskilled worker who smoked 20 cigarettes/day for 30 years had a 27% predicted probability for post-BD-AO at age 53 if she continued to smoke. The predicted risk was 42% if she had coexistent active asthma, but only 4.5% if she had quit after age 43. CONCLUSION: This novel and validated risk-prediction model could identify adults aged in their 40s at high 10-year COPD-risk in the general population with potential to facilitate active monitoring/intervention in predicted ‘COPD cases’ at a much earlier age. BMJ Publishing Group 2021-12-02 /pmc/articles/PMC8640628/ /pubmed/34857526 http://dx.doi.org/10.1136/bmjresp-2021-001138 Text en © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. https://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) .
spellingShingle Respiratory Epidemiology
Perret, Jennifer L
Vicendese, Don
Simons, Koen
Jarvis, Debbie L
Lowe, Adrian J
Lodge, Caroline J
Bui, Dinh S
Tan, Daniel
Burgess, John A
Erbas, Bircan
Bickerstaffe, Adrian
Hancock, Kerry
Thompson, Bruce R
Hamilton, Garun S
Adams, Robert
Benke, Geza P
Thomas, Paul S
Frith, Peter
McDonald, Christine F
Blakely, Tony
Abramson, Michael J
Walters, E Haydn
Minelli, Cosetta
Dharmage, Shyamali C
Ten-year prediction model for post-bronchodilator airflow obstruction and early detection of COPD: development and validation in two middle-aged population-based cohorts
title Ten-year prediction model for post-bronchodilator airflow obstruction and early detection of COPD: development and validation in two middle-aged population-based cohorts
title_full Ten-year prediction model for post-bronchodilator airflow obstruction and early detection of COPD: development and validation in two middle-aged population-based cohorts
title_fullStr Ten-year prediction model for post-bronchodilator airflow obstruction and early detection of COPD: development and validation in two middle-aged population-based cohorts
title_full_unstemmed Ten-year prediction model for post-bronchodilator airflow obstruction and early detection of COPD: development and validation in two middle-aged population-based cohorts
title_short Ten-year prediction model for post-bronchodilator airflow obstruction and early detection of COPD: development and validation in two middle-aged population-based cohorts
title_sort ten-year prediction model for post-bronchodilator airflow obstruction and early detection of copd: development and validation in two middle-aged population-based cohorts
topic Respiratory Epidemiology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8640628/
https://www.ncbi.nlm.nih.gov/pubmed/34857526
http://dx.doi.org/10.1136/bmjresp-2021-001138
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