Implications of using the GLI-2012, GOLD and Australian COPD-X recommendations in assessing the severity of airflow limitation on spirometry among an Indigenous population with COPD: An Indigenous Australians perspective study

Subash Heraganahally, Timothy P. Howarth, Elisha White, Helmi Ben Saad

Research output: Contribution to journalArticlepeer-review

1 Downloads (Pure)

Abstract

Background Assessment of airflow limitation (AFL) is crucial in the clinical evaluation of patients with chronic obstructive pulmonary disease (COPD). However, in the absence of normative reference values among adult Australian Indigenous population, the implications of utilising the Global Lung Function Initiative (GLI-2012), Global Initiative for Chronic Obstructive Lung Disease (GOLD) and the Australian concise COPD-X recommended severity classifications is not known. Moreover, spirometry values (forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV 1)) are observed to be 20%-30% lower in an apparently healthy Indigenous population in comparison to Caucasian counterparts. 

Methods Adult Indigenous patients diagnosed to have COPD on spirometry (postbronchodilator (BD) FEV 1 /FVC <0.7 ((GOLD, (COPD-X)) and ≤lower limit of normal (others/mixed reference equations) for GLI-2012) were assessed for AFL severity classifications on Post-BD FEV 1 values (mild, moderate, severe, very severe) as per the recommended classifications. 

Results From a total of 742 unique patient records of Indigenous Australians, 253 were identified to have COPD via GOLD/COPD-X criteria (n=238) or GLI-2012 criteria (n=238) with significant agreeance between criteria (96%, κ=0.901). Of these, the majority were classified as having moderate or severe/very-severe AFL with significant variability across classification criteria (COPD-X (40%-43%), GOLD (33%-65%), GLI-2012 (18%-75%)). The FVC and FEV 1 values also varied significantly between classification criterion (COPD-X/GOLD/GLI-2012) within the same AFL category, with COPD-X moderate' AFL almost matching severe' AFL categorisation by GOLD or GLI-2012.

Conclusions Health professionals caring for Indigenous patients with COPD should be aware of the clinical implications and consequences of utilising various recommended AFL classifications in the absence of validated spirometry reference norms among adult Indigenous patients.

Original languageEnglish
Article numbere001135
Number of pages11
JournalBMJ Open Respiratory Research
Volume8
Issue number1
DOIs
Publication statusPublished - 24 Dec 2021

Fingerprint

Dive into the research topics of 'Implications of using the GLI-2012, GOLD and Australian COPD-X recommendations in assessing the severity of airflow limitation on spirometry among an Indigenous population with COPD: An Indigenous Australians perspective study'. Together they form a unique fingerprint.

Cite this