Cargando…
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...
Autores principales: | , , , , , , , , , , , , , , , , , , , , , , , |
---|---|
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 |
_version_ | 1784609369186369536 |
---|---|
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. |
format | Online Article Text |
id | pubmed-8640628 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | BMJ Publishing Group |
record_format | MEDLINE/PubMed |
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 |
work_keys_str_mv | AT perretjenniferl tenyearpredictionmodelforpostbronchodilatorairflowobstructionandearlydetectionofcopddevelopmentandvalidationintwomiddleagedpopulationbasedcohorts AT vicendesedon tenyearpredictionmodelforpostbronchodilatorairflowobstructionandearlydetectionofcopddevelopmentandvalidationintwomiddleagedpopulationbasedcohorts AT simonskoen tenyearpredictionmodelforpostbronchodilatorairflowobstructionandearlydetectionofcopddevelopmentandvalidationintwomiddleagedpopulationbasedcohorts AT jarvisdebbiel tenyearpredictionmodelforpostbronchodilatorairflowobstructionandearlydetectionofcopddevelopmentandvalidationintwomiddleagedpopulationbasedcohorts AT loweadrianj tenyearpredictionmodelforpostbronchodilatorairflowobstructionandearlydetectionofcopddevelopmentandvalidationintwomiddleagedpopulationbasedcohorts AT lodgecarolinej tenyearpredictionmodelforpostbronchodilatorairflowobstructionandearlydetectionofcopddevelopmentandvalidationintwomiddleagedpopulationbasedcohorts AT buidinhs tenyearpredictionmodelforpostbronchodilatorairflowobstructionandearlydetectionofcopddevelopmentandvalidationintwomiddleagedpopulationbasedcohorts AT tandaniel tenyearpredictionmodelforpostbronchodilatorairflowobstructionandearlydetectionofcopddevelopmentandvalidationintwomiddleagedpopulationbasedcohorts AT burgessjohna tenyearpredictionmodelforpostbronchodilatorairflowobstructionandearlydetectionofcopddevelopmentandvalidationintwomiddleagedpopulationbasedcohorts AT erbasbircan tenyearpredictionmodelforpostbronchodilatorairflowobstructionandearlydetectionofcopddevelopmentandvalidationintwomiddleagedpopulationbasedcohorts AT bickerstaffeadrian tenyearpredictionmodelforpostbronchodilatorairflowobstructionandearlydetectionofcopddevelopmentandvalidationintwomiddleagedpopulationbasedcohorts AT hancockkerry tenyearpredictionmodelforpostbronchodilatorairflowobstructionandearlydetectionofcopddevelopmentandvalidationintwomiddleagedpopulationbasedcohorts AT thompsonbrucer tenyearpredictionmodelforpostbronchodilatorairflowobstructionandearlydetectionofcopddevelopmentandvalidationintwomiddleagedpopulationbasedcohorts AT hamiltongaruns tenyearpredictionmodelforpostbronchodilatorairflowobstructionandearlydetectionofcopddevelopmentandvalidationintwomiddleagedpopulationbasedcohorts AT adamsrobert tenyearpredictionmodelforpostbronchodilatorairflowobstructionandearlydetectionofcopddevelopmentandvalidationintwomiddleagedpopulationbasedcohorts AT benkegezap tenyearpredictionmodelforpostbronchodilatorairflowobstructionandearlydetectionofcopddevelopmentandvalidationintwomiddleagedpopulationbasedcohorts AT thomaspauls tenyearpredictionmodelforpostbronchodilatorairflowobstructionandearlydetectionofcopddevelopmentandvalidationintwomiddleagedpopulationbasedcohorts AT frithpeter tenyearpredictionmodelforpostbronchodilatorairflowobstructionandearlydetectionofcopddevelopmentandvalidationintwomiddleagedpopulationbasedcohorts AT mcdonaldchristinef tenyearpredictionmodelforpostbronchodilatorairflowobstructionandearlydetectionofcopddevelopmentandvalidationintwomiddleagedpopulationbasedcohorts AT blakelytony tenyearpredictionmodelforpostbronchodilatorairflowobstructionandearlydetectionofcopddevelopmentandvalidationintwomiddleagedpopulationbasedcohorts AT abramsonmichaelj tenyearpredictionmodelforpostbronchodilatorairflowobstructionandearlydetectionofcopddevelopmentandvalidationintwomiddleagedpopulationbasedcohorts AT waltersehaydn tenyearpredictionmodelforpostbronchodilatorairflowobstructionandearlydetectionofcopddevelopmentandvalidationintwomiddleagedpopulationbasedcohorts AT minellicosetta tenyearpredictionmodelforpostbronchodilatorairflowobstructionandearlydetectionofcopddevelopmentandvalidationintwomiddleagedpopulationbasedcohorts AT dharmageshyamalic tenyearpredictionmodelforpostbronchodilatorairflowobstructionandearlydetectionofcopddevelopmentandvalidationintwomiddleagedpopulationbasedcohorts AT tenyearpredictionmodelforpostbronchodilatorairflowobstructionandearlydetectionofcopddevelopmentandvalidationintwomiddleagedpopulationbasedcohorts |