2015
DOI: 10.1001/jamainternmed.2015.2735
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Abstract: IMPORTANCE Airflow obstruction on spirometry is universally used to define chronic obstructive pulmonary disease (COPD), and current or former smokers without airflow obstruction may assume that they are disease free.OBJECTIVE To identify clinical and radiologic evidence of smoking-related disease in a cohort of current and former smokers who did not meet spirometric criteria for COPD, for whom we adopted the discarded label of Global Initiative for Obstructive Lung Disease (GOLD) 0. DESIGN, SETTING, AND PARTI… Show more

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Cited by 372 publications
(321 citation statements)
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“…In persons without previously documented airflow limitation, many of the confirmed CLRD cases were subphenotyped as asthma, which is not defined by fixed airflow limitation; however, persons without airflow limitation also gave rise to one-fourth of confirmed COPD cases. These findings are consistent with recent reports of the clinical importance of respiratory exacerbations and related events in persons without documented baseline airflow limitation in the CanCOLD (35), MESA (7), COPDGene (8), and SPIROMICS (9) studies. Such events may correspond to dynamic airflow limitation attributable to emphysematous lung changes or asthma-COPD overlap (2), which were not uncommon in the present study.…”
Section: Discussionsupporting
confidence: 92%
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“…In persons without previously documented airflow limitation, many of the confirmed CLRD cases were subphenotyped as asthma, which is not defined by fixed airflow limitation; however, persons without airflow limitation also gave rise to one-fourth of confirmed COPD cases. These findings are consistent with recent reports of the clinical importance of respiratory exacerbations and related events in persons without documented baseline airflow limitation in the CanCOLD (35), MESA (7), COPDGene (8), and SPIROMICS (9) studies. Such events may correspond to dynamic airflow limitation attributable to emphysematous lung changes or asthma-COPD overlap (2), which were not uncommon in the present study.…”
Section: Discussionsupporting
confidence: 92%
“…However, standard approaches to identifying and classifying CLRD cases and CLRD exacerbations in cohort studies or administrative databases are lacking. Spirometric definitions of COPD may be insufficient to detect persons at risk of CLRD exacerbations and CLRDrelated mortality (6)(7)(8)(9)(10)(11)(12)(13), and the validity of administrative definitions for CLRD exacerbations remains uncertain (14)(15)(16). Central physician adjudication of medical records for major adverse cardiac events is a routine approach to minimizing bias in cardiovascular cohort studies and randomized clinical trials (17,18), and yet no similar standard has been applied to CLRD events, even in major randomized clinical trials (19)(20)(21)(22).…”
mentioning
confidence: 99%
“…Chronic respiratory symptoms may precede the development of airflow limitation and may exist in individuals with normal spirometry. 2,3 Across the world, tobacco smoking is the commonest risk factor for COPD. 4 Both active and passive smoking account for respiratory symptoms.…”
Section: Introductionmentioning
confidence: 99%
“…[3] They found one or more respiratory-related impairments in 54.1% (2 375/4 388) of smokers or ex-smokers with normal spirometry. This group had worse quality of life than the never-smokers (mean St George's Respiratory Questionnaire total score 17.0 (18.0) v. 3.8 (6.8), p<0 .001) and a lower 6-minute walk distance, and 42.3% (127/300) had computed tomography (CT) evidence of emphysema or airway thickening.…”
Section: Breath-taking Newsmentioning
confidence: 96%