What is early COPD and why is it important?

Soriano, Joan B.; Polverino, Francesca; Cosío, Borja G.

doi:10.1183/13993003.01448-2018

Cited by 104 publications

(81 citation statements)

References 78 publications

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“…More importantly, several studies have confirmed that emphysema is an independent risk factor for patient mortality, and is independent of airflow limitation 7 . Smokers without spirometrically diagnosed COPD have been overlooked in clinical practice 5,21,22 . Therefore, emphysematous smokers with normal spirometry should receive early intervention to prevent progression of structural destruction, improve their quality of life, and prolong their survival time [5][6][7][8][23][24][25] .…”

Section: Discussionmentioning

confidence: 99%

Comparative analysis of pathophysiological parameters between emphysematous smokers and emphysematous patients with COPD

Bai

Wang

et al. 2020

Sci Rep

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emphysematous smokers with normal spirometry form a considerable proportion of the clinical population. However, despite presenting with respiratory symptoms and activity limitation, they cannot be diagnosed with chronic obstructive lung disease (copD) according to current criteria. thus, we aimed to determine whether emphysema in smokers has a different pathogenesis from that in patients with COPD. We compared 12 pairs of lung tissue samples from emphysematous patients with normal spirometry and copD, and determined the degree of emphysema using computed tomography. With a focus on COPD-related pathogenesis, we independently assessed inflammatory response, protease-antiprotease balance, oxidative stress, and apoptosis in both groups. Both groups showed similar pathological changes at a comparable degree of emphysema; the expression of inflammatory factors was comparable, with overexpression of proteases and decreased levels of antiproteases. Moreover, there was no significant difference in the activities of glutathione and superoxide dismutase, and expression of apoptosis-related factors. in conclusion, emphysema in smokers with normal spirometry and in patients with COPD had similar pathogenesis. Forced expiratory volume in 1 second cannot be used as the sole diagnostic criterion in patients with copD; early intervention is of great importance to such patients. Chronic obstructive lung disease (COPD) is a chronic respiratory airway disease, with symptoms such as cough, sputum, and shortness of breath 1. The two most prominent pathological changes associated with COPD are the structural destruction of lung tissue and airway remodelling 2. Currently, spirometry is the sole diagnostic criterion for COPD 1,3. Forced expiratory volume in 1 second (FEV1) primarily reflects airflow obstruction and is therefore not suitable for assessing COPD symptoms such as emphysema 4-8. Studies have shown that there is a poor correlation between FEV1 and COPD symptoms 5,6 , as well between FEV1 and the degree of emphysema, as assessed by computed tomography (CT) 7,8. Patients with COPD show high heterogeneity in terms of clinical symptoms, structural destruction, and airway damage 9,10. In some patients, structural destruction of lung tissue is more prominent, and their emphysema severity develops progressively 11. These patients are termed emphysema phenotype of COPD 12,13 , and their structure destruction can be assessed with chest CT scans 14,15. However, chest CT scans have revealed that a considerable number of smokers with obvious emphysema and lung tissue damage show preserved pulmonary function 14-16. According to the current diagnostic criteria, such emphysematous smokers cannot be diagnosed with COPD. If they have same pathogenesis as patients with emphysematous COPD, appropriate interventions to reduce the clinical symptoms and block emphysema progression would be challenging in emphysematous smokers 5,17. In this study, we hypothesized that emphysematous smokers with normal spirometry and emphysematous patients with COP...

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Section: Discussionmentioning

confidence: 99%

Comparative analysis of pathophysiological parameters between emphysematous smokers and emphysematous patients with COPD

Bai

Wang

et al. 2020

Sci Rep

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“…However, the recommendation that persons less than 50 years old should be considered to have an early disease does not take into consideration that a majority of smokers start in their teens and hence would already have accumulated a substantial number of pack-years of smoking burden by the time they are in their forties. Additionally, the terms "early" and "mild" should be used with caution when talking about COPD pathogenesis 31 . According to the current state of the art, "mild" COPD is based on a spirometric measurement, whereas "early" relates to the time when COPD is diagnosed or studied for the first time, and both may not be coincident in the same individual.…”

Section: Early Versus Late Copdmentioning

confidence: 99%

“…Also, "early" versus "late" COPD belong to a timescale, which does not necessarily mirror the time when the pathogenesis of the disease started. Part of the confusion is that, at present, it is not possible to differentiate mild COPD of recent onset from earlier onset COPD that does not progress to a more severe stage 31,32 .…”

Section: Early Versus Late Copdmentioning

confidence: 99%

“…Others may have susceptible hematopoietic cells of the lung that initiate abnormal response of B cells 58,59 , ultimately leading to the destruction of the alveolar structures and emphysema. According to this new view, in order to reliably sub-phenotype COPD, it is critical to study younger cohorts of subjects at risk for developing COPD so that the endotypes can be identified 31 . The advantage of looking at upstream cohort is that, while the pathology and clinical presentation of the established COPD may be identical, the pathobiological origins of the disease are different.…”

Section: Barcelona Respiratory Networkmentioning

confidence: 99%

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The Many Faces of Chronic Obstructive Pulmonary Disease: Moving Towards Precision Medicine

Polverino¹

2021

BRN

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When the term chronic obstructive pulmonary disease (COPD) was first used in 1970s, it included two main phenotypes: the "blue bloater" (chronic bronchitis) and "pink puffer" (emphysema). Recently, as our current knowledge on the disease has progressed, the attention has been drawn to very diverse subtypes of chronic airflow obstruction characterised by different causes, age of onset, pathological and clinical manifestations. Over the years, "recommendations" have been generated for the clinicians on how to manage the patients with COPD, such as the Global Initiative for Chronic Obstructive Lung Disease (GOLD) recommendations. Although the GOLD recommendations had the great merit to draw attention onto the COPD severity and its clinical management, they are now less suitable to address the extremely diverse nature of COPD. This review will give an overview of the history of COPD, and the many faces of COPD over the years to date. (BRN Rev. 2019;5(2):90-103)

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“…Although this dose is much smaller than that of a heavy smoker, one must consider that exposure to household air pollution starts prenatally and is sustained during childhood, adolescence and adulthood. This is important if one considers that COPD pathogenesis may begin early in life, as recently discussed in the Controversies in COPD series in the ERJ [17]. Early exposure to air pollution affects airway function and lung growth, which can lead to reduced maximum attained adult lung function that, in turn, may interact with accelerated decline in lung function and lead to early onset COPD [15,17].…”

mentioning

confidence: 99%

Household air pollution as an important factor in the complex relationship between altitude and COPD

Basagaña

2019

Eur Respir J

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What is early COPD and why is it important?

Cited by 104 publications

References 78 publications

Comparative analysis of pathophysiological parameters between emphysematous smokers and emphysematous patients with COPD

Comparative analysis of pathophysiological parameters between emphysematous smokers and emphysematous patients with COPD

The Many Faces of Chronic Obstructive Pulmonary Disease: Moving Towards Precision Medicine

Household air pollution as an important factor in the complex relationship between altitude and COPD

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