PhD defence by Stine Hangaard Caspersen
Stine Hangaard Caspersen will defend her PhD thesis: Challenges and new potential in COPD diagnosis and pulmonary function testing"
12.10.2018 kl. 13.00 - 17.00
Chronic obstructive pulmonary disease (COPD) is a chronic lung disease characterized by airflow limitation. All patients with relevant respiratory symptoms who have been exposed to known risk factors for COPD should be considered for diagnostic evalua-tion. A diagnosis of COPD is based on spirometry. A post-bronchodilator forced ex-piratory volume in 1 second/forced vital capacity (FEV1/FVC) < 0.7 confirms the presence of COPD. It is essential that COPD is diagnosed correctly so that appropriate treatment can be initiated. However, COPD remains highly undiagnosed and misdiag-nosed. Spirometry is the key pulmonary function test in COPD diagnosis and monitor-ing even though spirometry proves problematic. The problems related to spirometry underline the need for alternative approaches in COPD pulmonary function testing.
The aim of the thesis was twofold. First, the thesis aimed to explore the challenges of underdiagnosis and misdiagnosis of COPD. Second, the thesis aimed to explore alter-natives to existing methods in COPD pulmonary function testing. The thesis was based on four studies represented in four individual papers. Paper I and Paper II concentrated on the first aim, whereas Paper III and Paper IV concentrated on Paper IV. Study I explored the characteristics of patients with undiagnosed COPD. Study II explored the causes of misdiagnosed COPD. Study III proposed to adjust the pre-bronchodilator threshold for spirometry-based diagnosis of COPD. Finally, Study IV validated the potential of a novel pulmonary function test; the SPOT test.
In conclusion, the diagnosis of COPD proves problematic. It is challenging to identify potential cases of COPD as patients with undiagnosed COPD are characterized by mild respiratory symptoms. Moreover, the causes of misdiagnosis are many, and they are mainly linked to the key pulmonary function test, spirometry. An adjustment of the pre-bronchodilator threshold from 0.7 to 0.66 may improve COPD diagnosis by limit-ing misclassification. However, such an adjustment is inadequate and there is a need for alternative pulmonary function tests in COPD. The SPOT test shows promise as a new pulmonary function test in COPD. However, further studies are needed to ensure the validity and the future role of the SPOT test in COPD diagnosis and monitoring.
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