• Laura E Labonté, Wan C Tan, Pei Z Li, Palmina Mancino, Shawn D Aaron, Andrea Benedetti, Kenneth R Chapman, Robert Cowie, J Mark FitzGerald, Paul Hernandez, François Maltais, Darcy D Marciniuk, Dennis O'Donnell, Don Sin, Jean Bourbeau, Canadian Respiratory Research Network, and CanCOLD Collaborative Research Group.
• 1 Respiratory Epidemiology and Clinical Research Unit, Research Institute of the McGill University Health Centre, and.
• Am. J. Respir. Crit. Care Med. 2016 Aug 1; 194 (3): 285-98.

RationaleChronic obstructive pulmonary disease (COPD) remains undiagnosed in many individuals with persistent airflow limitation. These individuals may be susceptible to exacerbation-like respiratory events that consume health care resources.ObjectivesTo compare exacerbation-like respiratory events, event prevalence, and differences in the odds of using medication and/or health services between subjects with diagnosed and undiagnosed COPD.MethodsSubjects sampled from the general population participating in the CanCOLD (Canadian Cohort Obstructive Lung Disease) study, with at least 12 months of exacerbation-event follow-up who were classified as having physician-diagnosed or undiagnosed COPD were assessed. Exacerbation-like respiratory events were captured using a questionnaire administered every 3 months.Measurements And Main ResultsA total of 355 subjects were undiagnosed and 150 were diagnosed with COPD. Undiagnosed subjects were less symptomatic and functionally impaired, had been prescribed fewer respiratory medications, and had better health status. The incidence of reported exacerbation-like events was higher in diagnosed subjects and increased in both groups with the severity of airflow obstruction. Although subjects with diagnosed COPD were more often prescribed medication for exacerbation events, health service use for exacerbation events was similar in both groups.ConclusionsMost subjects with COPD in Canada remain undiagnosed. These subjects are less symptomatic and impaired, which may partly explain lack of diagnosis. Although patients with undiagnosed COPD experience fewer exacerbations than those with diagnosed COPD, they use a similar amount of health services for exacerbation events; thus, the overall health system burden of exacerbations in those with undiagnosed COPD is considerable.

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