Even with symptoms, GOLD staging misses African American cases
By Lori Solomon HealthDay Reporter
WEDNESDAY, Aug. 2, 2023 (HealthDay News) — The fixed-ratio spirometric criteria for chronic obstructive pulmonary disorder (COPD) underdiagnoses potential COPD in African American patients, according to a study recently published in the Journal of General Internal Medicine.
Elizabeth A. Regan, M.D., Ph.D., from National Jewish Health in Denver, and colleagues compared COPD diagnosis by fixed ratio with findings and outcomes by race. The analysis included current or former smokers with ≥10-pack-year smoking history.
The researchers found that using the fixed ratio, 70 percent of African Americans were classified as non-COPD versus 49 percent of non-Hispanic White patients. Twelve-year mortality was similar for African American smokers despite being younger (55 versus 62 years), more often currently smoking (80 versus 39 percent), and having fewer pack-years. For forced expiratory volume in the first one second (FEV1) and forced vital capacity (FVC) raw spirometry values, density distribution plots showed disproportionate reductions in FVC relative to FEV1 in African Americans that systematically led to higher ratios. African Americans with GOLD 0 stage had greater symptoms; worse diffusing capacity for carbon monoxide, spirometry, and BODE scores; and greater deprivation than White participants in a matched analysis.
“Broader diagnostic criteria for COPD are needed to identify the disease across all populations,†the authors write.
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