Clinical pre-COPD case-finding in the general population: self-reported exertional dyspnea versus mMRC in the Constances Cohort

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Clinical pre-COPD is defined by chronic respiratory symptoms including chronic cough and sputum, and dyspnea in the absence of airway obstruction (FEV1/FVC>0.70). This study aimed to assess two approaches to identify the presence of exertional dyspnea in participants at risk. Among 114,346 participants with data from spirometry, questionnaires: symptoms, mMRC dyspnea scale, and smoking history; 17,634 were considered at risk (age 40+ years, >10 pack-years) and included in the analyses. Two approaches were tested: a mMRC dyspnea grade≥1 and a positive answer to "Have you experienced an attack of shortness of breath following strenuous activity (SOB_SA) in the past 12 months?". The prevalence of mMRC ≥1 was 28.6%, and that of SOB_SA was 30.2%. Only 59.1% of participants with mMRC≥1 also reported SOB_SA. When SOB_SA was used in the pre-COPD definition, prevalence was 4.2%; using mMRC≥1, it was 4.6%. The weighted Kappa coefficient was 0.66 [0.65-0.67] overall and was lower in the youngest (40-44 years: 0.62 [0.58-0.66]) than in the oldest (65-75 years: 0.68 [0.64-0.71). It was 0.70 [0.68-0.71] for men and 0.61 [0.59-0.63] for women. For the most deprived, the Kappa was 0.67 [0.64-0.70] vs. 0.63 [0.59-0.67] for the less deprived. For a BMI ≥30kg/m2, the Kappa was 0.61 [0.58-0.65] vs. 0.66 [0.64-0.68] for a normal BMI [18.5-25kg/m2[. The agreement between mMRC and exertional dyspnea was substantial, partly explained by differences in activity definition. This agreement varied by age, sex, BMI and socioeconomic status, suggesting the need to standardize dyspnea assessment for an adequate case-finding of pre-COPD.

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