Natural history of COPD: gaps and opportunities

Agustí, Àlvar; Celli, Bartolomé R.

doi:10.1183/23120541.00117-2017

Cited by 46 publications

(36 citation statements)

References 90 publications

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“…It is possible that cases attributed to asthma during childhood (COPDa) may relate to the fact that a child with lung developmental problems is likely to experience some form of respiratory symptoms ( e.g. dyspnoea on exercise and wheezing) and be diagnosed with “asthma” if taken to a paediatrician [ 71 ].…”

Section: An Improved Taxonomy Proposalmentioning

confidence: 99%

COPD: time to improve its taxonomy?

Celli

Agustí

2018

ERJ Open Res

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Due to well-conducted epidemiological studies and advances in genetics, molecular biology, translational research, the advent of computed tomography of the lungs and bioinformatics, the diagnosis of chronic obstructive pulmonary disease (COPD) as a single entity caused by susceptibility to cigarette smoke is no longer tenable. Furthermore, the once-accepted concept that COPD results from a rapid and progressive loss of lung function over time is not true for a sizeable proportion of adults with the disease. Now we know that some genetic predisposition and/or different environmental interactions (nutritional, infectious, pollution and immunological) may negatively modulate post-natal lung development and lead to poorly reversible airflow limitation later in life, consistent with COPD. We believe it is time to rethink the taxonomy of this disease based on the evidence at hand. To do so, we have followed the principles outlined in the 1980s by J.D. Scadding who proposed that diseases can be defined by four key characteristics: 1) clinical description (syndrome), 2) disorder of structure (morbid anatomy), 3) disorder of function (pathophysiology) and 4) causation (aetiology). Here, we propose a pragmatic approach to the taxonomy of COPD based on different processes that result in a similar syndromic presentation. It can accommodate changes over time, as the pathobiology that may lead to COPD expands. We hope that stakeholders in the field may find it useful to better define the patients now boxed into one single entity, so that specific studies can be designed and conducted for each type of COPDs.

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Section: An Improved Taxonomy Proposalmentioning

confidence: 99%

COPD: time to improve its taxonomy?

Celli

Agustí

2018

ERJ Open Res

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“…Multidimensional indicators are increasingly used not only for the diagnosis of COPD but also for prognosis. These indexes have greater prognostic value in comparison with the isolated spirometry measurement 35 . The body mass index, airflow obstruction, dyspnea score, and exercise (BODE) index (acronym for BODE capacity) has demonstrated to be better than FEV 1 for predicting the risk of death due to any cause and due to respiratory causes in patients with COPD 36 , which is to be expected up to a certain point in that it incorporates multiple domains of the disease and is expected to vary less over time 37,38 .…”

Section: Multidimensional Indicators In Copdmentioning

confidence: 98%

Controversies and Limitations in the Diagnosis of Chronic Obstructive Pulmonary Disease

Reyes-García

Torre-Bouscoulet

Pérez‐Padilla

2019

RIC

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Chronic obstructive pulmonary disease (COPD) is a major cause of chronic morbidity and mortality worldwide. While the cutoff point to define airflow obstruction has been controversial, it is widely accepted that the spirometry test is vital, as well as performing it after using a bronchodilator. The 6-second spirometry and the forced expiratory volume in 1 second/forced expiratory volume in 6 seconds (FEV 1 /FEV 6) have demonstrated validity for defining obstruction, and it would be advisable to incorporate them in the definitions of obstruction. Another relevant issue is that spirometry with borderline obstruction can vary over time, changing to above or below the cutoff point. Thus, surveillance should be considered over time, repeating the spirometry to have a greater certainty in the diagnosis. The objective of this article was to conduct an in-depth review of the controversies in the diagnosis of COPD. During the past years, COPD definition has been updated in different times; however, it is now considered more as a complex syndrome with systemic participation, requiring a multidimensional assessment, and not only a spirometry.

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“…The word early is a time adjective describing the situation at or very near the beginning of a process and it is commonly used when the starting point of a procedure cannot be defined with accuracy [44,47].…”

Section: Early Copdmentioning

confidence: 99%

EARLY versus MILD Chronic Obstructive Pulmonary Disease (COPD)

Siafakas

Bizymi

Mathioudakis

et al. 2018

Respiratory Medicine

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Chronic Obstructive Pulmonary Disease (COPD) is very a common, with great morbidity and mortality, disease. Since the beginning of the disease cannot be detected with precision and by using only FEV1 to monitor the evolution of the disease, the Natural History of COPD is rather obscure and sometimes controversial. Therefore, the terms EARLY COPD and MILD COPD have been used indistinguishably in the medical literature. In this review we discuss the two terms trying to clarify some of the definition issues, starting with a synopsis of the Naturel History of the disease. We recommend to use the term EARLY COPD for the pre-clinical stage of the disease (stage 0) and the term MILD COPD when the diagnosis is confirmed by spirometry and FEV1 is above 80% predicted. However, COPD is a complex disease and spirometric evaluation alone (MILD COPD, stage I), cannot fully describe the clinical status of the patient. We conclude that biomarkers to detect the starting point and been able to follow the natural history of the disease more accurately, beyond FEV, are urgently needed.

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Natural history of COPD: gaps and opportunities

Cited by 46 publications

References 90 publications

COPD: time to improve its taxonomy?

COPD: time to improve its taxonomy?

Controversies and Limitations in the Diagnosis of Chronic Obstructive Pulmonary Disease

EARLY versus MILD Chronic Obstructive Pulmonary Disease (COPD)

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