Ten-year prediction model for post-bronchodilator airflow obstruction and early detection of COPD: Development and validation in two middle-aged population-based cohorts

Jennifer L. Perret; Don Vicendese; Koen Simons; Debbie L. Jarvis; Adrian J. Lowe; Caroline J. Lodge; Dinh S. Bui; Daniel Tan; John A. Burgess; Bircan Erbas; Adrian Bickerstaffe; Kerry Hancock; Bruce R. Thompson; Garun S. Hamilton; Robert Adams; Geza P. Benke; Paul S. Thomas; Peter Frith; Christine F. Mcdonald; Tony Blakely; Michael J. Abramson; E. Haydn Walters; Cosetta Minelli; Shyamali C. Dharmage; TAHS and ECRHS Investigator Groups

doi:10.1136/bmjresp-2021-001138

Ten-year prediction model for post-bronchodilator airflow obstruction and early detection of COPD: Development and validation in two middle-aged population-based cohorts

Jennifer L. Perret, Don Vicendese, Koen Simons, Debbie L. Jarvis, Adrian J. Lowe, Caroline J. Lodge, Dinh S. Bui, Daniel Tan, John A. Burgess, Bircan Erbas, Adrian Bickerstaffe, Kerry Hancock, Bruce R. Thompson, Garun S. Hamilton, Robert Adams, Geza P. Benke, Paul S. Thomas, Peter Frith, Christine F. Mcdonald, Tony BlakelyMichael J. Abramson, E. Haydn Walters, Cosetta Minelli, Shyamali C. Dharmage, TAHS and ECRHS Investigator Groups

College of Medicine and Public Health

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Abstract

Background: Classifying individuals at high chronic obstructive pulmonary disease (COPD)-risk creates opportunities for early COPD detection and active intervention. Objective: To develop and validate a statistical model to predict 10-year probabilities of COPD defined by post-bronchodilator airflow obstruction (post-BD-AO; forced expiratory volume in 1 s/forced vital capacity<5th percentile). Setting: General Caucasian populations from Australia and Europe, 10 and 27 centres, respectively. Participants: For the development cohort, questionnaire data on respiratory symptoms, smoking, asthma, occupation and participant sex were from the Tasmanian Longitudinal Health Study (TAHS) participants at age 41-45 years (n=5729) who did not have self-reported COPD/emphysema at baseline but had post-BD spirometry and smoking status at age 51-55 years (n=2407). The validation cohort comprised participants from the European Community Respiratory Health Survey (ECRHS) II and III (n=5970), restricted to those of age 40-49 and 50-59 with complete questionnaire and spirometry/smoking data, respectively (n=1407). Statistical method: Risk-prediction models were developed using randomForest then externally validated. Results: Area under the receiver operating characteristic curve (AUC ROC) of the final model was 80.8% (95% CI 80.0% to 81.6%), sensitivity 80.3% (77.7% to 82.9%), specificity 69.1% (68.7% to 69.5%), positive predictive value (PPV) 11.1% (10.3% to 11.9%) and negative predictive value (NPV) 98.7% (98.5% to 98.9%). The external validation was fair (AUC ROC 75.6%), with the PPV increasing to 17.9% and NPV still 97.5% for adults aged 40-49 years with ≥1 respiratory symptom. To illustrate the model output using hypothetical case scenarios, a 43-year-old female unskilled worker who smoked 20 cigarettes/day for 30 years had a 27% predicted probability for post-BD-AO at age 53 if she continued to smoke. The predicted risk was 42% if she had coexistent active asthma, but only 4.5% if she had quit after age 43. Conclusion: This novel and validated risk-prediction model could identify adults aged in their 40s at high 10-year COPD-risk in the general population with potential to facilitate active monitoring/intervention in predicted 'COPD cases' at a much earlier age.

Original language	English
Article number	e001138
Journal	BMJ Open Respiratory Research
Volume	8
Issue number	1
DOIs	https://doi.org/10.1136/bmjresp-2021-001138
Publication status	Published - 2 Dec 2021

Bibliographical note

Funding Information:
The TAHS was supported by the National Health and Medical Research Council (NHMRC) of Australia, research grants 299901 and 1021275; the University of Melbourne; Clifford Craig Foundation; the Victorian, Queensland and Tasmanian Asthma Foundations; Royal Hobart Hospital; Helen MacPherson Smith Trust; GlaxoSmithKline; and John L Hopper. JP, AL and SCD are funded through the NHMRC of Australia. The ECRHS was supported by grants from the European Commission (018996) and Medical Research Council (ECRHS III no. 92091), and multiple local grants that supported study testing centres of ECRHS II and III which have been listed in the acknowledgement section. These sponsors of the study had no role in study design, data collection, data analysis, data interpretation or writing of the report. The corresponding author had full access to all the data in the study and had final responsibility for the decision to submit for publication.

Publisher Copyright:
© 2021 Author(s) (or their employer(s)).

Keywords

clinical epidemiology
COPD epidemiology

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Perret, J. L., Vicendese, D., Simons, K., Jarvis, D. L., Lowe, A. J., Lodge, C. J., Bui, D. S., Tan, D., Burgess, J. A., Erbas, B., Bickerstaffe, A., Hancock, K., Thompson, B. R., Hamilton, G. S., Adams, R., Benke, G. P., Thomas, P. S., Frith, P., Mcdonald, C. F., ... TAHS and ECRHS Investigator Groups (2021). Ten-year prediction model for post-bronchodilator airflow obstruction and early detection of COPD: Development and validation in two middle-aged population-based cohorts. BMJ Open Respiratory Research, 8(1), [e001138]. https://doi.org/10.1136/bmjresp-2021-001138

@article{75db2cf2176246f4af1869f5c687bd5a,

title = "Ten-year prediction model for post-bronchodilator airflow obstruction and early detection of COPD: Development and validation in two middle-aged population-based cohorts",

abstract = "Background: Classifying individuals at high chronic obstructive pulmonary disease (COPD)-risk creates opportunities for early COPD detection and active intervention. Objective: To develop and validate a statistical model to predict 10-year probabilities of COPD defined by post-bronchodilator airflow obstruction (post-BD-AO; forced expiratory volume in 1 s/forced vital capacity<5th percentile). Setting: General Caucasian populations from Australia and Europe, 10 and 27 centres, respectively. Participants: For the development cohort, questionnaire data on respiratory symptoms, smoking, asthma, occupation and participant sex were from the Tasmanian Longitudinal Health Study (TAHS) participants at age 41-45 years (n=5729) who did not have self-reported COPD/emphysema at baseline but had post-BD spirometry and smoking status at age 51-55 years (n=2407). The validation cohort comprised participants from the European Community Respiratory Health Survey (ECRHS) II and III (n=5970), restricted to those of age 40-49 and 50-59 with complete questionnaire and spirometry/smoking data, respectively (n=1407). Statistical method: Risk-prediction models were developed using randomForest then externally validated. Results: Area under the receiver operating characteristic curve (AUC ROC) of the final model was 80.8% (95% CI 80.0% to 81.6%), sensitivity 80.3% (77.7% to 82.9%), specificity 69.1% (68.7% to 69.5%), positive predictive value (PPV) 11.1% (10.3% to 11.9%) and negative predictive value (NPV) 98.7% (98.5% to 98.9%). The external validation was fair (AUC ROC 75.6%), with the PPV increasing to 17.9% and NPV still 97.5% for adults aged 40-49 years with ≥1 respiratory symptom. To illustrate the model output using hypothetical case scenarios, a 43-year-old female unskilled worker who smoked 20 cigarettes/day for 30 years had a 27% predicted probability for post-BD-AO at age 53 if she continued to smoke. The predicted risk was 42% if she had coexistent active asthma, but only 4.5% if she had quit after age 43. Conclusion: This novel and validated risk-prediction model could identify adults aged in their 40s at high 10-year COPD-risk in the general population with potential to facilitate active monitoring/intervention in predicted 'COPD cases' at a much earlier age.",

keywords = "clinical epidemiology, COPD epidemiology",

author = "Perret, {Jennifer L.} and Don Vicendese and Koen Simons and Jarvis, {Debbie L.} and Lowe, {Adrian J.} and Lodge, {Caroline J.} and Bui, {Dinh S.} and Daniel Tan and Burgess, {John A.} and Bircan Erbas and Adrian Bickerstaffe and Kerry Hancock and Thompson, {Bruce R.} and Hamilton, {Garun S.} and Robert Adams and Benke, {Geza P.} and Thomas, {Paul S.} and Peter Frith and Mcdonald, {Christine F.} and Tony Blakely and Abramson, {Michael J.} and Walters, {E. Haydn} and Cosetta Minelli and Dharmage, {Shyamali C.} and {TAHS and ECRHS Investigator Groups} and Heather Gibson and Bryan Gandevia and Harold Silverstone and Norelle Lickiss and Mark Jenkins and John Hopper and James Markos and Richard Wood-Baker and Iain Feather",

note = "Funding Information: The TAHS was supported by the National Health and Medical Research Council (NHMRC) of Australia, research grants 299901 and 1021275; the University of Melbourne; Clifford Craig Foundation; the Victorian, Queensland and Tasmanian Asthma Foundations; Royal Hobart Hospital; Helen MacPherson Smith Trust; GlaxoSmithKline; and John L Hopper. JP, AL and SCD are funded through the NHMRC of Australia. The ECRHS was supported by grants from the European Commission (018996) and Medical Research Council (ECRHS III no. 92091), and multiple local grants that supported study testing centres of ECRHS II and III which have been listed in the acknowledgement section. These sponsors of the study had no role in study design, data collection, data analysis, data interpretation or writing of the report. The corresponding author had full access to all the data in the study and had final responsibility for the decision to submit for publication. Publisher Copyright: {\textcopyright} 2021 Author(s) (or their employer(s)).",

year = "2021",

month = dec,

day = "2",

doi = "10.1136/bmjresp-2021-001138",

language = "English",

volume = "8",

journal = "BMJ Open Respiratory Research",

issn = "2052-4439",

number = "1",

}

Perret, JL, Vicendese, D, Simons, K, Jarvis, DL, Lowe, AJ, Lodge, CJ, Bui, DS, Tan, D, Burgess, JA, Erbas, B, Bickerstaffe, A, Hancock, K, Thompson, BR, Hamilton, GS, Adams, R, Benke, GP, Thomas, PS, Frith, P, Mcdonald, CF, Blakely, T, Abramson, MJ, Walters, EH, Minelli, C, Dharmage, SC & TAHS and ECRHS Investigator Groups 2021, 'Ten-year prediction model for post-bronchodilator airflow obstruction and early detection of COPD: Development and validation in two middle-aged population-based cohorts', BMJ Open Respiratory Research, vol. 8, no. 1, e001138. https://doi.org/10.1136/bmjresp-2021-001138

TY - JOUR

T1 - Ten-year prediction model for post-bronchodilator airflow obstruction and early detection of COPD

T2 - Development and validation in two middle-aged population-based cohorts

AU - Perret, Jennifer L.

AU - Vicendese, Don

AU - Simons, Koen

AU - Jarvis, Debbie L.

AU - Lowe, Adrian J.

AU - Lodge, Caroline J.

AU - Bui, Dinh S.

AU - Tan, Daniel

AU - Burgess, John A.

AU - Erbas, Bircan

AU - Bickerstaffe, Adrian

AU - Hancock, Kerry

AU - Thompson, Bruce R.

AU - Hamilton, Garun S.

AU - Adams, Robert

AU - Benke, Geza P.

AU - Thomas, Paul S.

AU - Frith, Peter

AU - Mcdonald, Christine F.

AU - Blakely, Tony

AU - Abramson, Michael J.

AU - Walters, E. Haydn

AU - Minelli, Cosetta

AU - Dharmage, Shyamali C.

AU - TAHS and ECRHS Investigator Groups

AU - Gibson, Heather

AU - Gandevia, Bryan

AU - Silverstone, Harold

AU - Lickiss, Norelle

AU - Jenkins, Mark

AU - Hopper, John

AU - Markos, James

AU - Wood-Baker, Richard

AU - Feather, Iain

N1 - Funding Information: The TAHS was supported by the National Health and Medical Research Council (NHMRC) of Australia, research grants 299901 and 1021275; the University of Melbourne; Clifford Craig Foundation; the Victorian, Queensland and Tasmanian Asthma Foundations; Royal Hobart Hospital; Helen MacPherson Smith Trust; GlaxoSmithKline; and John L Hopper. JP, AL and SCD are funded through the NHMRC of Australia. The ECRHS was supported by grants from the European Commission (018996) and Medical Research Council (ECRHS III no. 92091), and multiple local grants that supported study testing centres of ECRHS II and III which have been listed in the acknowledgement section. These sponsors of the study had no role in study design, data collection, data analysis, data interpretation or writing of the report. The corresponding author had full access to all the data in the study and had final responsibility for the decision to submit for publication. Publisher Copyright: © 2021 Author(s) (or their employer(s)).

PY - 2021/12/2

Y1 - 2021/12/2

N2 - Background: Classifying individuals at high chronic obstructive pulmonary disease (COPD)-risk creates opportunities for early COPD detection and active intervention. Objective: To develop and validate a statistical model to predict 10-year probabilities of COPD defined by post-bronchodilator airflow obstruction (post-BD-AO; forced expiratory volume in 1 s/forced vital capacity<5th percentile). Setting: General Caucasian populations from Australia and Europe, 10 and 27 centres, respectively. Participants: For the development cohort, questionnaire data on respiratory symptoms, smoking, asthma, occupation and participant sex were from the Tasmanian Longitudinal Health Study (TAHS) participants at age 41-45 years (n=5729) who did not have self-reported COPD/emphysema at baseline but had post-BD spirometry and smoking status at age 51-55 years (n=2407). The validation cohort comprised participants from the European Community Respiratory Health Survey (ECRHS) II and III (n=5970), restricted to those of age 40-49 and 50-59 with complete questionnaire and spirometry/smoking data, respectively (n=1407). Statistical method: Risk-prediction models were developed using randomForest then externally validated. Results: Area under the receiver operating characteristic curve (AUC ROC) of the final model was 80.8% (95% CI 80.0% to 81.6%), sensitivity 80.3% (77.7% to 82.9%), specificity 69.1% (68.7% to 69.5%), positive predictive value (PPV) 11.1% (10.3% to 11.9%) and negative predictive value (NPV) 98.7% (98.5% to 98.9%). The external validation was fair (AUC ROC 75.6%), with the PPV increasing to 17.9% and NPV still 97.5% for adults aged 40-49 years with ≥1 respiratory symptom. To illustrate the model output using hypothetical case scenarios, a 43-year-old female unskilled worker who smoked 20 cigarettes/day for 30 years had a 27% predicted probability for post-BD-AO at age 53 if she continued to smoke. The predicted risk was 42% if she had coexistent active asthma, but only 4.5% if she had quit after age 43. Conclusion: This novel and validated risk-prediction model could identify adults aged in their 40s at high 10-year COPD-risk in the general population with potential to facilitate active monitoring/intervention in predicted 'COPD cases' at a much earlier age.

AB - Background: Classifying individuals at high chronic obstructive pulmonary disease (COPD)-risk creates opportunities for early COPD detection and active intervention. Objective: To develop and validate a statistical model to predict 10-year probabilities of COPD defined by post-bronchodilator airflow obstruction (post-BD-AO; forced expiratory volume in 1 s/forced vital capacity<5th percentile). Setting: General Caucasian populations from Australia and Europe, 10 and 27 centres, respectively. Participants: For the development cohort, questionnaire data on respiratory symptoms, smoking, asthma, occupation and participant sex were from the Tasmanian Longitudinal Health Study (TAHS) participants at age 41-45 years (n=5729) who did not have self-reported COPD/emphysema at baseline but had post-BD spirometry and smoking status at age 51-55 years (n=2407). The validation cohort comprised participants from the European Community Respiratory Health Survey (ECRHS) II and III (n=5970), restricted to those of age 40-49 and 50-59 with complete questionnaire and spirometry/smoking data, respectively (n=1407). Statistical method: Risk-prediction models were developed using randomForest then externally validated. Results: Area under the receiver operating characteristic curve (AUC ROC) of the final model was 80.8% (95% CI 80.0% to 81.6%), sensitivity 80.3% (77.7% to 82.9%), specificity 69.1% (68.7% to 69.5%), positive predictive value (PPV) 11.1% (10.3% to 11.9%) and negative predictive value (NPV) 98.7% (98.5% to 98.9%). The external validation was fair (AUC ROC 75.6%), with the PPV increasing to 17.9% and NPV still 97.5% for adults aged 40-49 years with ≥1 respiratory symptom. To illustrate the model output using hypothetical case scenarios, a 43-year-old female unskilled worker who smoked 20 cigarettes/day for 30 years had a 27% predicted probability for post-BD-AO at age 53 if she continued to smoke. The predicted risk was 42% if she had coexistent active asthma, but only 4.5% if she had quit after age 43. Conclusion: This novel and validated risk-prediction model could identify adults aged in their 40s at high 10-year COPD-risk in the general population with potential to facilitate active monitoring/intervention in predicted 'COPD cases' at a much earlier age.

KW - clinical epidemiology

KW - COPD epidemiology

UR - http://www.scopus.com/inward/record.url?scp=85121030438&partnerID=8YFLogxK

UR - http://purl.org/au-research/grants/nhmrc/299901

UR - http://purl.org/au-research/grants/nhmrc/1021275

U2 - 10.1136/bmjresp-2021-001138

DO - 10.1136/bmjresp-2021-001138

M3 - Article

AN - SCOPUS:85121030438

VL - 8

JO - BMJ Open Respiratory Research

JF - BMJ Open Respiratory Research

SN - 2052-4439

IS - 1

M1 - e001138

ER -

Ten-year prediction model for post-bronchodilator airflow obstruction and early detection of COPD: Development and validation in two middle-aged population-based cohorts

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