Chest
Volume 124, Issue 2, August 2003, Pages 474-481
Journal home page for Chest

Clinical Investigations
COPD
The Proportional Venn Diagram of Obstructive Lung Disease*: Two Approximations From the United States and the United Kingdom

https://doi.org/10.1378/chest.124.2.474Get rights and content

Study objectives

The nonproportional Venn diagram of obstructive lung disease (OLD) produced for the 1995 American Thoracic Society guidelines has not been quantified. We aim to quantify the proportion of the general population with OLD and the intersections of physician-diagnosed asthma, chronic bronchitis, and emphysema in the United States and the United Kingdom, and to examine the relationship to obstructive spirometry.

Design and participants

We analyzed data from the US National Health and Nutrition Examination (NHANES) III survey (1988 to 1994) and the UK General Practice Research Database for the year 1998.

Results

The areas of intersection among the three OLD conditions produced seven mutually exclusive disease groups. The asthma-only group was the largest proportion of OLD patients, accounting for 50.3% and 79.4% of all OLD patients in the United States and the United Kingdom, respectively, and decreased with increasing age. Overall, 17% and 19% of OLD patients in the United States and in the United Kingdom, respectively, reported more than one OLD condition, and this percentage increased with age. According to the spirometry data from NHANES III, only 37.4% of emphysema-only patients had objective airflow obstruction. The prevalence of airflow obstruction was significantly higher among participants with combinations of emphysema and chronic bronchitis (57.7%), with emphysema and asthma (51.9%), and with all three OLD diseases concomitantly (52.0%).

Conclusion

Concomitant diagnosis of asthma, chronic bronchitis, or emphysema is common among OLD patients from the general population, particularly in adults aged ≥ 50 years.

Section snippets

Data Sources

We analyzed data from the US National Health and Nutrition Examination (NHANES) III survey, conducted from 1988 to 1994, and the UK General Practice Research Database (GPRD) for the year 1998.

The NHANES III was a cross-sectional, multistage probability sample (n = 33,994) that was representative of the total noninstitutionalized civilian population of the United States, and surveys were conducted from 1988 to 1994.78 Information about the medical history of respiratory symptoms and diagnoses of

Results

The descriptive characteristics of NHANES III and GPRD participants with OLD are presented in Table 1. Patients were stratified into seven mutually exclusive disease groups by age and sex for each study population. Patients with asthma, in whom diagnoses had been made with or without other OLD conditions, were younger than COPD patients. The combination of asthma with chronic bronchitis, but not with emphysema, was associated with younger age.

In the US NHANES III total population, the

Discussion

Our analysis highlights the problem of the differential diagnosis among OLDs, particularly in older adults and the elderly. By analyzing large samples of patients from the general population in the United States and the United Kingdom, we demonstrated that a substantial number of patients are diagnosed with two or even all three OLD conditions concomitantly. By analyzing the NHANES III spirometry data, we observed that diagnoses of asthma, chronic bronchitis, and emphysema are present with and

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This study was supported by GlaxoSmithKline Research and Development.

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