Respiratory care
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COPD is largely underdiagnosed. Patients with undiagnosed COPD need to be diagnosed to ensure early treatment institution. It is therefore relevant to obtain a more profound understanding of the characteristics of patients with undiagnosed COPD to improve COPD case finding. This study aimed to explore the characteristics of subjects with undiagnosed COPD from the United States National Health and Nutrition Examination Survey (NHANES) dataset (2007-2012) based on post-bronchodilator spirometry. ⋯ Subjects with undiagnosed COPD were characterized by fewer symptoms and had better lung function than their diagnosed counterparts.
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COPD is a leading cause of morbidity and mortality worldwide. Spirometry is the most common lung function test for diagnosing COPD with a post-bronchodilator FEV1/FVC < 0.70 confirming the presence of the disease. However, diagnosticians appear reluctant to use bronchodilators, which have been linked to the misdiagnosis of COPD. Therefore, we investigated whether the threshold for diagnosing COPD should be modified when diagnosing COPD based on pre-bronchodilator spirometry. ⋯ We suggest a slight adjustment using pre-bronchodilator FEV1/FVC < 0.66 when diagnosing COPD based on pre-bronchodilator spirometry. This approach could prevent cases of misdiagnosed COPD, which can lead to potentially harmful treatment of people who do not have COPD and foregone treatment in patients with COPD.
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A simple exercise test to evaluate for exercise-induced bronchoconstriction (EIB) is routinely ordered in pediatric patients with exercise-induced dyspnea. However, the utility of this test in establishing the cause of exercise-induced dyspnea is not thoroughly examined in the pediatric population. We sought to assess the efficiency of a simple EIB challenge test in finding the cause of exercise-induced dyspnea in pediatric patients referred to our tertiary center in the last 5 y. ⋯ In a majority of subjects without asthma, a simple EIB challenge testing failed to uncover the cause of exercise-induced dyspnea and thus was inefficient. In these subjects, cardiopulmonary exercise testing may be more useful and cost-effective to explore other causes of dyspnea including EIB.