RT Journal Article
SR Electronic
T1 Ten-year prediction model for post-bronchodilator airflow obstruction and early detection of COPD: development and validation in two middle-aged population-based cohorts
JF BMJ Open Respiratory Research
JO BMJ Open Resp Res
FD British Thoracic Society
SP e001138
DO 10.1136/bmjresp-2021-001138
VO 8
IS 1
A1 Jennifer L Perret
A1 Don Vicendese
A1 Koen Simons
A1 Debbie L Jarvis
A1 Adrian J Lowe
A1 Caroline J Lodge
A1 Dinh S Bui
A1 Daniel Tan
A1 John A Burgess
A1 Bircan Erbas
A1 Adrian Bickerstaffe
A1 Kerry Hancock
A1 Bruce R Thompson
A1 Garun S Hamilton
A1 Robert Adams
A1 Geza P Benke
A1 Paul S Thomas
A1 Peter Frith
A1 Christine F McDonald
A1 Tony Blakely
A1 Michael J Abramson
A1 E Haydn Walters
A1 Cosetta Minelli
A1 Shyamali C Dharmage
A1 ,
YR 2021
UL http://bmjopenrespres.bmj.com/content/8/1/e001138.abstract
AB 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 (AUCROC) 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 (AUCROC 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.Data are available upon reasonable request. TAHS is a cohort study with data that has been prospectively collected since 1968 and will be an ongoing resource for future epidemiological analyses. Data collection protocols have been detailed in the TAHS cohort profile paper published in 2016 (Matheson et al 2016 doi: 10.1093/ije/dyw028). The raw data have not been made widely available, but expressions of interest can be discussed with the corresponding author, Dr J Perret, and/or principal investigator, Professor S Dharmage, on an individual basis. ECRHS is a cohort study with data that has been prospectively collected since 1990 and will be an ongoing resource for future epidemiological analyses. Data collection protocols are detailed at https://www.ecrhs.org/. The raw data have not been made widely available, but expressions of interest can be discussed with the principal investigator, Professor D Jarvis, on an individual basis.