Early Detection and Impaired Quality of Life in COPD GOLD Stage 0: A Pilot Study

Abstract

This pilot study aimed to identify early stages of chronic obstructive pulmonary disease (COPD) in an urban population of smokers and ex-smokers using the Global Initiative for Chronic Obstructive Lung Disease (GOLD 2001, 2003) classification guidelines and to assess the impact of early disease on quality of life. Smokers and ex-smokers of >or= 10 pack years and age >or= 50 years were recruited. After an initial telephone interview, eligible subjects completed a clinical assessment, spirometry tests, and the St. George's Respiratory Questionnaire (SGRQ). A total of 244 subjects completed the study; 91 subjects (37%) were normal, 153 subjects (63%) met the criteria for GOLD stages 0 to III: 65 stage 0 (27%), 43 stage I (18%), 38 stage II (16%), 7 stage III (3%) and 0 in stage IV. The stage 0 patients were younger than any other COPD groups (p<0.0005), including normal subjects (55.5+/-5.4 years vs. 59.6+/-7.2 years; p=0.0005). The frequency of current smoking in stage 0 patients was greater than those in the normal category (80% vs. 33%; p<0.0001). There were significant impairments in quality of life measures between normal subjects and all GOLD stages (SGRQ total scores; p<0.0001) except for stage I (SGRQ total scores; p=0.1409). Subjects with COPD at GOLD stage 0 were markedly under-diagnosed. These subjects had a significant impairment in their health-related quality of life measures, were younger than other categories, and were mostly current smokers. Thus, detection of COPD at GOLD stage 0 may provide a unique opportunity for early intervention and smoking cessation and the removal of GOLD stage 0 from the 2006 update should be re-assessed.

Prevalence and underdiagnosis of chronic obstructive pulmonary disease among patients at risk in primary care

“…3 Our estimate of COPD prevalence in a sample of more than 1000 individuals is more precise (20.7%, 95% CI 18.3%-23.4%) and agrees with earlier reports of a high prevalence of COPD among people with known risk factors. [4][5][6] Although underdiagnosis of COPD has been previously reported, 20 the extent of it in our cohort is especially striking given that all of the patients had two important risk factors for COPD. 3 Moreover, almost 50% of the patients with COPD were still smoking and therefore at increased risk for progression to more severe disease.…”

“…1,2 A recent global population-based study estimated the prevalence of the disease to be about 10% among people 40 years of age and older. 3 People with known risk factors for COPD, such as increased age and a history of smoking, are likely to have a substanially higher prevalence [4][5][6] and to have progressive manifestations of COPD if they continue to smoke. 7 They are thus appropriate targets for intervention early in the course of their disease.…”

COPD, chronic bronchitis and capacity for day-to-day activities: Negative impact of illness on the health-related quality of life

“…36 The removal of GOLD stage 0 from the 2006 update should be re-assessed. 37 The strength of this study is the large populationbased sample. Thus, the number of people with COPD was only 277.…”

Mechanisms of exercise intolerance in Global Initiative for Chronic Obstructive Lung Disease grade 1 COPD

“…Despite having relatively preserved spirometry, patients with milder chronic obstructive pulmonary disease (COPD) show increased mortality [1], increased hospitalisations, and decreased health-related quality of life [2][3][4][5] compared with nonsmoking controls. Many of these patients also experience exertional dyspnoea [6], which may partially explain their reduced physical activity levels [7].…”