Factors that delay COPD detection in the general elderly population.

Background: In patients with COPD, early detection and rapid treatment are essential to prevent its progression and exacerbations.

Objective: To identify factors that delay COPD detection.

Methods: We conducted a cross-sectional study of elderly COPD patients and healthy subjects in rural Japan. We measured respiratory and physical function (hand grip force, maximum inspiratory pressure, maximum expiratory pressure, total trace length, and toe grasp force), walking ability, and quality of life (QOL, measured with a visual analog scale). We conducted spirometry in 408 subjects, whom we divided into 2 groups: those whose ratio of FEV(1) to forced vital capacity (FVC) was < 70% (the airway-obstruction group, n = 60), and those whose FEV(1)/FVC was ≥ 70% (the healthy-subjects group, n = 348). To avoid confounding, we then matched 60 subjects from the healthy-subjects group to the 60 in the airway-obstruction group for age, sex, height, and smoking history, so both groups had 60 subjects.

Results: Physical function was significantly inferior in the airway-obstruction group. Variables reflecting instantaneous walking ability (maximum walking speed and walking time in the 10-m hurdle walk) were significantly inferior in the airway-obstruction group, but there were no significant differences in 6-min-walk test, which reflects walking endurance, or in QOL.

Conclusions: Walking endurance, QOL, and proximal muscle strength in the extremities of patients with COPD were well preserved, which prevented detection of COPD and hampered the subjects' motive for seeking medical care. In consequence, lack of awareness impeded the early detection of COPD. In primary healthcare for the general elderly population, spirometry is much easier to conduct than physical function tests, so we recommend that spirometry screening programs for early-stage COPD detection and staging.