Online Data Supplement Prevalence of Chronic Obstructive Pulmonary Disease in Korea: Results of a Population-based Spirometry Survey Dong Soon Kim, MD, Young Sam Kim MD, Kee Suk Chung MD, Jung Hyun Chang MD, Chae-Man Lim MD, Jae Ho Lee MD, Soo-Taek Uh MD, Jae Jeong Shim MD, Woo Jin Lew, MD On Behalf of the Korean Academy of Tuberculosis and Respiratory Diseases
* Questionnaires for the respiratory symptoms and physician-diagnosed respiratory diseases. 1. Has a doctor ever told you that you had chronic bronchitis, emphysema, or COPD? 2. Do you bring up phlegm on most days for 3 consecutive months or more during the year? * If yes, how many years? a: one year, b: two years, c: more than 2 years, d: don t know. 3. Do you usually cough on most days for 3 consecutive months or more during the year? *If yes, how many years? a: one year, b: two years, c: more than 2 years, d: don t know. 4. Are you troubled by shortness of breath when hurrying on level ground or walking uphill?" 5. Has a doctor ever told you that you had asthma? 6. Have you had wheezing or whistling in your chest at nay time in the last 12 months? 1.1 Have you been at all breathless when the wheezing noise was present?
1.2 Have you had this wheezing or whistling when you did not have a cold? 7. Have you had an attack of asthma (sudden bouts of cough and shortness of breath with wheezing) in the last 12 months? 8. Are you currently taking any medication, (including inhalers, aerosols or tablets) for asthma, chronic bronchitis, empysema or COPD? 9. Walking 400 meters (5-10 min walking distance), or carrying things about 4 kg is a: difficult, b: slightly difficult c: much difficult, d: unable to do. 10. Because of these symptoms or health problem, do you need help for a ordinary activity?
DEFINITION: *Smoker was defined as smoking more than 100 cigarettes during the lifetime (NHANES III, U.S.), and ex-smokers as having quit smoking more than 6 months before (7). *Definition of obstructive lung disease GOLD criteria: FEV 1 /FVC< 70%. British Thoracic Society (BTS) and NHANES III criteria: FEV 1 /FVC< 70% and FEV 1 < 80% predicted, ERS criteria: FEV1/vital capacity ratio < 88% predicted and < 89% predicted in men and women, respectively 1985 ATS criteria: FEV 1 < 75% *Definition of COPD: obstructive lung disease in the subjects over 45 years of age. *The severity of obstruction was classified according to GOLD. GOLD stage I: FEV 1 /FVC < 0.70 and FEV 1 > 80% predicted GOLD stage II: FEV 1 /FVC < 0.70 and FEV 1 50% - 79% predicted, GOLD stage III: FEV 1 /FVC < 0.70 and FEV 1 30 49% predicted GOLD stage IV: FEV 1 /FVC < 0.70 and FEV 1 < 30% predicted.
120.0 100.0 96.3 96.3 95.6 96.4 95.8 93.3 93.5 87.7 Non- Smokers 1-10 pack- years 11-20 pack- years 20 pack- years> 80.0 78.8 77.2 75.6 71.3 60.0 40.0 20.0 0.0 FVC(Pred):(%) FEV1(Pred):(%) FEV1/FVC(%) Figure E1. Relationship of lung function and smoking. All parameters of the spirometry were significantly lower in smokers compared to nonsmoker and the degree of reduction was correlated with the amount of smoking.
Table E1. The Age Specific Percentage of People with Airway Obstruction by BTS/NHANES Criteria. Age (Years) BTS / NHANES Criteria (%) Total Male Female 18 24 1.1 0.6 1.6 25 44 1.2 2.0 0.6 45 64 4.5 7.0 2.3 65 74 18.5 27.6 10.1 >75 17.2 30.0 3.6 Age > 45 7.7 11.8 4.0 Total 3.6±0.3* 5.2± 0.4* 2.1± 0.3* BTS/NHANES III criteria: : FEV 1 /FVC< 70% and FEV 1 < 80% predicted,
Table E2. The Prevalence of COPD (Among the People Older Than 45 Years of Age) Stratified by Smoking Status and the Severity of COPD (%) Smoking Status Prevalence of COPD among the study subjects (Age> 45 years) Percentage of smokers among the subjects with COPD (Age> 45 years) Mild Moderate Severe Mild Moderate Severe Non-Smoker 5.1 3.5 0.2 34.3 34.0 9.1 Former 14.1 9.1 4.1 23.3 21.3 45.4 Current 14.1 10.5 2.3 42.5 44.7 45.5 < 10 pack-year 8.3 4.5 0.0 7.6 5.9 0.0 11 19 pack-year 9.4 8.0 1.5 9.0 10.8 9.1 > 20 pack-year 18.0 12.9 4.6 48.6 49.0 81.8 Total 8.7 6.2 1.3 100 100 100 Mild (GOLD stage I): FEV 1 /FVC < 0.70 and FEV 1 > 80%, Moderate (GOLD stage II): FEV 1 /FVC < 0.70 and FEV 1 : 50% - 80%, Severe (GOLD stage III and IV): FEV 1 /FVC < 0.70 and FEV 1 < 50%.
Table E3. Frequency of Respiratory Symptoms and Physician Diagnosis in the Subjects Older than 45 years of Age with COPD Stratified by Severity (GOLD) (%) Normal GOLD stage I II III or IV Cough more than 3 months over one year 4.4 4.1 8.9 54.6 Sputum more than 3 months over one year 8.1 10.3 13.7 59.1 Cough or sputum more than 3 months over one year 10.0 11.0 15.5 68.2 Wheezing during last 12 months 6.1 8.2 24.3 59.1 Physician diagnosis of COPD 6.8 8.2 16.7 63.6 Current use of medications 1.2 2.1 9.7 36.4 Mild (GOLD stage I): FEV 1 /FVC < 0.70 and FEV 1 > 80%, Moderate (GOLD stage II): FEV 1 /FVC < 0.70 and FEV 1 : 50% - 80%, Severe (GOLD stage III and IV): FEV 1 /FVC < 0.70 and FEV 1 < 50%.
Table E4. Comparison of the Prevalence of Obstructive Lung Disease by the Same British Thoracic Society Criteria on the Same Stratification of the Subjects BTS Criteria Korea NHANES III (U.S.A.) Norway (Bakke)* Total Male Female Total Male Female Total Age (> 18 years) 3.6 5.2 2.1 6.8 4.5 Severe (FEV 1 < 50%) 0.6 1.2 0.1 1.5 Smoking Never- 2.0 2.7 1.8 3.0 Former 8.8 8.9 5.9 9.7 Current 6.3 7.0 5.8 10.2 BTS Criteria: British Thoracic Society Criteria: FEV 1 /FVC< 70% and FEV 1 < 80% predicted. NHANES III: National Health and Nutritional Examination Survey in U.S.A. (Ref. 7) *: ref.1
Table E5. Comparison of the Prevalence of Airway Obstruction by the Same GOLD Criteria on the Same Stratification of the Subjects Smoking GOLD Criteria (FEV 1 /FVC < 70%) Korea Viegi * Total Male Female Total Male Female Age > 18 years 7.8 10.9 4.9 18.3 23.1 13.4 Severe disease** 0.6 1.0 0.1 2.1 Age < 45years 1.3 2.5 0.1 9.9 13.3 6.5 Age > 45 years 17.2 25.8 9.6 28.7 33.1 22.2 Severe disease** 1.3 2.7 0.1 4.4 Smoker (>18 years) 8.2 12.8 4.3 18.3 23.3 13.8 Never- 4.5 6.9 4.1 14 15.1 10.5 Former 18.4 18.9 5.9 21 27.9 14.5 Current 12.7 13.0 9.2 18 22.2 14.4 Smoker (> 45years) 16.2 25.5 7.9 28.7 33.1 22.2 Never- 8.8 14.6 7.6 22 28.2 19.8 Former 27.3 27.8 12.5 30 32.7 15.9 Current 26.9 28.6 12.5 35 34.9 37.3 > 20 pack-year 35.6 35.7 30.8 *: Some of the data are recalculated from the Table 3 of ref. 10 ** Severe disease: FEV 1 <50%
Table E6. Comparison of the Prevalence of Obstructive Lung Disease by the Same American Thoracic Society Criteria on the Same Stratification of the Subjects ATS Criteria (FEV 1 < 75%) Korea Vigie * Shin ** No. of subjects 3,755 2841 (>25Y: 1,727) 1,160 Total Male F Total Male F Total Male F Age > 18years 18.4 26.5 11.7 40.4 45 36 10.3 17 5.6 Age < 45 years 7.3 10.9 4.4 27 32 22.2 3.8 6.5 2.3 Severe disease 0.5 Age > 45years 33.8 46.8 22.1 57 60.7 53.4 18% 26.7 10.3 Mod-severe 3.8 5.3 2.4 2.9 Smoker Current 49 50.9 33.3 54 62.3 37.3 20 Ex-smoker 46.4 47 25 50 61.8 16.9 17.6 Never 24 24 21.4 20 38.7 19.8 10.8 >20PY 57.5 57.3 61.5 30 Mod-severe: FEV 1 < 59% predicted *: Some of the data are recalculated from the Table 3 of ref. 10 **: ref. 39.
Table E7. Comparison of the Prevalence of Obstructive Lung Disease by the Same European Respiratory Society Criteria on the Same Stratification of the Subjects ERS Criteria Korea Vigie* IBERPOC** Total Male F Total Male F Total Male F Age > 18 y 9.3 12.1 7.0 11.0 12.5 11.8 Age > 45 y 11.9 15.9 8.3 12.2 14.5 12 9.1 14.3 3.9 Smoker Never- 7.3 8.7 3.0 9 5.1 10.6 4.1 Former 19.8 20.1 12.5 15 16.7 11.3 12.8 Current 18 18.7 12.5 15 14 17.9 15 >20 pack-year 24.2 24.3 23.1 Moderate-severe 4.0 6.6 1.7 3.6 Geographic 5.6-16.7 5.1-21.4 3.0-20.0 4.9-18 difference Moderate-severe: FEV 1 < 69% predicted *: Some of the data are recalculated from the Table 3 of ref. 10 **: ref. 8