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Background: The burden of undiagnosed obstructive lung disease (OLD) (mainly asthma and chronic obstructive pulmonary disease) is not fully established, and targets for corrective action are yet to be identified. We assessed the underdiagnosis of OLD and its determinants in France., Methods: CONSTANCES is a French population-based cohort of adults aged 18-69 years at inception. We analysed data collected at inclusion in 2013-2014. Undiagnosed OLD was defined as spirometry-confirmed airflow limitation (FEV 1 /FVC < lower limit of normal) without prior diagnosis of asthma, chronic obstructive pulmonary disease, or bronchiectasis. Multivariate analysis was performed with weighted robust Poisson regression models to estimate the adjusted prevalence ratios (aPR) of undiagnosed OLD., Results: Spirometry results were available for 19,398 participants. The prevalence of airflow limitation was 4.6%. Overall, 64.4% of adults with airflow limitation did not report a previous diagnosis of OLD. Individuals with high cumulative tobacco consumption (≥ 10 pack-years) (aPR: 1.72 [1.28-2.32]), without respiratory symptoms (aPR: 1.51 [1.28-1.78]), and with preserved lung function (aPR: 1.21 [1.04-1.41] for a 10-point increase in FEV 1 % predicted) had a higher risk of being undiagnosed. Half of symptomatic individuals with airflow limitation (45% of those with moderate to severe airflow limitation) were undiagnosed with OLD., Conclusion: Underdiagnosis of OLD is very common among French adults, even in patients with respiratory symptoms. Efforts should be made in France to raise awareness about OLD in the general population, improve the detection of respiratory symptoms, and increase the use of spirometry among primary care professionals., (© 2021. The Author(s).)

Introduction: Hospitalizations for acute exacerbation of chronic obstructive pulmonary disease (AECOPD) are increasing in France. AECOPD are associated with impaired health status and increased health care costs., Methods: Using data from the French national health insurance information system, we studied mortality, readmissions and lung function testing after discharge among adults hospitalized for AECOPD in 2013., Results: The cumulative probabilities of death and readmission for EACOPD were 21% and 31% respectively. The survival was better among women, even after taking into account the other risk factors (age, previous hospitalization for AECOPD, comorbidities, exacerbation severity). In multivariate analysis, the risk of readmission was increased among men and people living in socially disadvantaged areas. A lung function testing was performed in 34% within 3 months after discharge. Female gender, advanced age, comorbidities and living in a disadvantaged area were associated with a lower frequency of lung function testing., Conclusions: Women had a better prognosis than men after AECOPD hospitalization. The frequency of lung function testing after discharge remained low, particularly among women and people living in disadvantaged areas., (Copyright © 2016 SPLF. Published by Elsevier Masson SAS. All rights reserved.)

Background: Acute exacerbations of chronic obstructive pulmonary disease (AE-COPD) necessitating hospital admission have a major impact on patient outcome and management costs. We examined temporal trends in AE-COPD-related hospital admissions in France between 1998 and 2007., Methods: Data were obtained from the French national hospital discharge database for patients aged at least 25 years. AE-COPD was identified with both a "narrow" and a "broad" definition, according to the position (primary or associated) of diagnoses, in order to ensure robustness., Results: In 2007, among adults aged 25 years or more, the crude AE-COPD-related admission rates were 23/10000 in men and 10/10000 in women using the narrow definition. Using the broad definition, these rates were respectively 38 and 16/10000. With the narrow definition, the annual number of AE-COPD-related admissions increased by 38% between 1998 and 2007, while in-hospital lethality decreased from 7.6% to 6.0%. The proportion of male patients decreased from 72% to 68%. Similar trends were found using the broad definition. The age-standardized AE-COPD-related admission rate increased by 4.4% per year in women and by 1.6% per year in men with the narrow definition, and by respectively 3.8% and 1.2% with the broad definition. A strong seasonal pattern of admissions for AE-COPD was found, matching that of general practitioners visits for influenza-like illness., Conclusion: Hospitalization rates for AE-COPD have increased in France in recent years, especially among women. By contrast, AE-COPD-related in-hospital lethality has decreased., (Copyright © 2010 Elsevier Ltd. All rights reserved.)

This paper aims to summarize the most recent data on the descriptive epidemiology of chronic obstructive pulmonary disease (COPD) in France. Data are presented concerning the prevalence, mortality and hospital admissions. The prevalence of COPD is difficult to estimate due to the large degree of under-diagnosis and the difficulty of performing spirometry in population-based epidemiological surveys. The prevalence of chronic bronchitis was estimated at 4%, and the prevalence of COPD was estimated at 5-10%, among adults aged 45 years and older. Data from death certificates, although limited by the accuracy of certification, showed that the annual age-standardised mortality rates from COPD increased between 1979 and 2000 among women but remained stable among men. In 2006, about 16,500 death certificates mentioned COPD, of which 7400 identified it as the underlying cause of death. According to the French national hospital discharge database, the number of admissions related to an exacerbation of COPD ranged from 69,000 to 112,000 in 2006 according to the definition used. The admission rates have increased between 1998 and 2006 and this increase was more pronounced among women than among men. Large regional differences in COPD mortality and hospital admission rates were evident, with the highest rates in Northern and Eastern France and in Brittany., (Copyright 2009 SPLF. Published by Elsevier Masson SAS. All rights reserved.)

Introduction: Chronic bronchitis is associated with an increased risk of COPD and health-related quality of life (HRQoL) impairment. The objectives of the study were to estimate the prevalence of chronic bronchitis and to describe its relations with quality of life., Methods: The French Health Interview Survey was conducted in 2003 in a representative sample of households. Data were collected during an interviewer's visits to the home. Respiratory symptoms and HRQoL (SF-36) were assessed in 9,050 adults aged 45 years and older using a self-administered questionnaire., Results: The prevalence of chronic bronchitis was estimated at 3.5%. Chronic bronchitis was associated with an impaired physical component summary score after adjusting for sex, age and dyspnoea. It was associated with a reduced mental component summary score (MCS) among men. In women, this association was only significant in the absence of dyspnoea., Conclusion: The prevalence of chronic bronchitis was 3.5% among adults aged 45 years and older. Chronic bronchitis was associated with impairment in health-related quality of life.

Background: A study was undertaken of deaths with an underlying or associated cause of chronic obstructive pulmonary disease (COPD), and trends in COPD mortality from 1979 to 2002 in France were analysed., Methods: Data were obtained from the Centre of Epidemiology on the Medical Causes of Death (CépiDc) for individuals aged 45 years and over. Owing to implementation of ICD-10 in 2000 for recording causes of death, two separate periods were analysed (1979-99 and 2000-2)., Results: In 2000-2, COPD was the underlying cause of 1.4% of deaths (deaths from COPD) and was mentioned on the death certificate in 3.0% (deaths with COPD). The other main underlying causes in these cases were cardiovascular diseases (32.0%) and cancers (24.5%). In 1979-99, age standardised rates of death with COPD remained stable in men (-0.01%/year) and increased in women (+1.7%/year). The mean annual rates of death with COPD per 100 000 were 84 for men and 19 for women in 2000-2., Conclusion: Multiple cause analysis improved the estimate of COPD related mortality. In 1979-99, COPD related mortality rates in France were stable in men but increased in women. Implementation of ICD-10 in 2000 introduced substantial discontinuities in mortality trends.