Disease progression in young patients with COPD: rethinking the Fletcher and Peto model

Abstract

Chronic obstructive pulmonary disease (COPD), although frequent in older individuals, can also occur at younger age; this latter population has not been well described.We reviewed the functional progression of 1708 patients with COPD attending pulmonary clinics. Those with three or more annual spirometries were divided into those who, at enrolment, were f55 (n5103) or o65 (n5463) years of age (younger and older COPD, respectively). Baseline and annual changes in lung function (forced expiratory volume in 1 s (FEV1)) and BODE (body mass index, airflow obstruction, dyspnoea, exercise capacity) score were recorded and compared between both groups. Severity distribution by Global Initiative for Chronic Obstructive Lung Disease and BODE scores were similar in both groups, except for mild obstruction, which was higher in the younger group. Mean FEV1 decline was 38.8 and 40.6 mL?year -1 , while BODE scores increased 0.19 and 0.23 units per year, for younger and older COPD, respectively. Both groups had similar proportion of FEV1 rapid decliners (42% and 46%, respectively).The severity distribution and progression of disease in younger patients with COPD is similar to that of patients of older age. This observation suggests that younger individuals presenting with COPD develop the disease from an already compromised pulmonary and systemic status, complementing the model of steeper decline of lung function proposed by Fletcher and Peto. @ERSpublications Baseline distribution of COPD severity and disease progression is similar in younger and older patients

Lung-Function Trajectories Leading to Chronic Obstructive Pulmonary Disease

“…[4][5][6][7][8][9][10][11][12][13][14][15][16] These observations question the notion that COPD always follows a trajectory of rapid decline in FEV 1 and are consistent with the hypothesis that low maximally attained lung function in early adulthood can also result in COPD later in life, even when the rate of decline in FEV 1 is within the normal range. [17][18][19][20][21] In fact, this alternative course was already suggested by Fletcher and Peto 3 and emphasized by Burrows et al 22 but was never explored in a long-term, prospective investigation. We used data from three large cohort studies to investigate this issue.…”

From COPD epidemiology to studies of pathophysiological disease mechanisms: challenges with regard to study design and recruitment process

“…non-rapid decliners, had a mean decline in FEV 1 of 26 ml (95%CI 23–29 ml) and 27 (18) ml per year, respectively. For comparison, in a study including patients from pulmonary clinics, rapid decline was set at 40 ml/year [32], based on the findings in the ECLIPSE study [33]. Our decision to employ 60 ml/year as a cutoff for group A, representing a more rapid decline in FEV 1 , and <30 ml/year, as a more normal rate of decline in FEV 1 for group B, can be considered well-motivated and in line with the above-referred publications.…”

The natural history of COPD: confirming and going beyond Fletcher and Peto

“…Data on females were provided by the Framingham Offspring Cohort [5] (4391 community residents followed for 23 years, of whom 51% were females) and by the Lung Health Study [6] (5885 COPD patients followed for o14.5 years, of whom 37% were females). The absence of data on females renders the study by SANCHEZ-SALCEDO et al [3] less applicable to population analysis for rates of change in forced expiratory volume in 1 s (FEV1). The Framingham cohort showed a lower decline in females who continued to smoke compared with males (23.9 versus 38.2 mL?yr -1 ), and fewer female smokers who developed airflow obstruction (24.2%) than male smokers (33.0%) [5].…”

“…Presciently, 37 years ago, this cohort demonstrated that not all smokers are susceptible to losing lung function and that in the susceptible smokers, continued smoking accelerates loss. As in the Fletcher-Peto cohort, which followed only males, and in the BODE (body mass index, airflow obstruction, dyspnoea, exercise capacity) cohort study by CASANOVA et al [4], in which 92% were male, the study by SANCHEZ-SALCEDO et al [3] is heavily weighted to males, with 85% of the younger and 92% of the older patients being male. Data on females were provided by the Framingham Offspring Cohort [5] (4391 community residents followed for 23 years, of whom 51% were females) and by the Lung Health Study [6] (5885 COPD patients followed for o14.5 years, of whom 37% were females).…”

“…In this issue of the European Respiratory Journal (ERJ), SANCHEZ-SALCEDO et al [3] contribute to our knowledge of chronic obstructive pulmonary disease (COPD) clinical status and progression in a study of 103 younger and 463 older patients followed for o2 years. All patients attended specialised pulmonary clinics, had smoked for o20 pack-years and were (presumably) symptomatic from their physiciandiagnosed COPD.…”