A Novel Spirometric Measure Identifies Mild COPD Unidentified by Standard Criteria

Dilektaşlı, Aslı Görek; Pórszász, János; Casaburi, Richard; Stringer, William W.; Bhatt, Surya P.; Pak, Youngju; Rossiter, Harry B.; Washko, George R.; Castaldi, Peter J.; Estépar, Raúl San Jośe; Hansen, James E.

doi:10.1016/j.chest.2016.06.047

Cited by 47 publications

(33 citation statements)

References 60 publications

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“…The present study adds to a previous study by Regan et al ,7 and the call for a broader definition of COPD and/or smoking-related lung disease is further underlined by a recent study by Dilektasli et al ,8 based on data from the COPDGene study that current and ex-smokers with prebronchodilator FEV 3 /FVC 6 <lower limit of normal as the sole abnormality identifies individuals with evidence of small airway disease on CT, impaired indices of physical capacity and quality of life.…”

Section: Commentarysupporting

confidence: 73%

Smokers with respiratory symptoms but no airflow limitation, often have activity limitation, exacerbations and evidence of airway disease

Ulrik

2016

Evid Based Med

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Section: Commentarysupporting

confidence: 73%

Smokers with respiratory symptoms but no airflow limitation, often have activity limitation, exacerbations and evidence of airway disease

Ulrik

2016

Evid Based Med

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“…New spirometric indices are trying to capture small airways obstruction where FEV1 failed in mild COPD patients. Current and ex-smokers with normal classic spirometry, but FEV3/FEV6 (forced expiratory volume at 3 and 6 s) ratio below LLN were identified as having small airway disease determined by quantitative CT, impaired physical function and quality of life [52]. Such indices have the great advantage of being broadly accessible.…”

Section: Functional Assessment Of Small Airwaysmentioning

confidence: 99%

COPD beyond proximal bronchial obstruction: phenotyping and related tools at the bedside

et al. 2019

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Chronic obstructive pulmonary disease (COPD) is characterised by nonreversible proximal bronchial obstruction leading to major respiratory disability. However, patient phenotypes better capture the heterogeneously reported complaints and symptoms of COPD. Recent studies provided evidence that classical bronchial obstruction does not properly reflect respiratory disability, and symptoms now form the new paradigm for assessment of disease severity and guidance of therapeutic strategies. The aim of this review was to explore pathways addressing COPD pathogenesis beyond proximal bronchial obstruction and to highlight innovative and promising tools for phenotyping and bedside assessment. Distal small airways imaging allows quantitative characterisation of emphysema and functional air trapping. Micro-computed tomography and parametric response mapping suggest small airways disease precedes emphysema destruction. Small airways can be assessed functionally using nitrogen washout, probing ventilation at conductive or acinar levels, and forced oscillation technique. These tests may better correlate with respiratory symptoms and may well capture bronchodilation effects beyond proximal obstruction.Knowledge of inflammation-based processes has not provided well-identified targets so far, and eosinophils probably play a minor role. Adaptative immunity or specific small airways secretory protein may provide new therapeutic targets. Pulmonary vasculature is involved in emphysema through capillary loss, microvascular lesions or hypoxia-induced remodelling, thereby impacting respiratory disability.

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“…Tests of small airway function are also impaired in smokers with asthma [46]. In the COPDGene cohort, current and ex-smokers without spirometric COPD (FEV1/FVC greater than lower limit of normal) had abnormal forced expiratory volume in 3 and 6 s (FEV3/FEV6) ratios that identified individuals with mild COPD characterised by CT small airway disease, impaired exercise tolerance and reduced quality of life [48]. In a 5-year follow-up of the COPDGene cohort, the rate of FEV1 decline was similar in current and ex-smokers without COPD who reported breathlessness or exacerbations compared with those who did not [42].…”

Section: Lung Functionmentioning

confidence: 99%

Asthma and smoking-induced airway disease without spirometric COPD

Thomson

2017

Eur Respir J

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Due to the high prevalence rates of cigarette smoking and asthma, current and ex-smokers frequently develop chronic airway disease without spirometric evidence of chronic obstructive pulmonary disease (COPD), either alone or associated with asthma. This review considers the classification, clinical outcomes, inflammatory and imaging variables, phenotypes, and management of current and ex-smokers with airway disease without COPD, focusing on overlaps in those with and without asthma. These individuals have more respiratory symptoms, worse quality of life, increased exacerbation rates, reduced lung function and more comorbidities than never-smokers with asthma or healthy never-smokers. As well as clinical features, airway inflammatory and structural changes in smoking-induced airway disease without COPD overlap with those found in smokers with asthma. Cigarette smoking is associated with worse clinical outcomes in some phenotypes of asthma. Management involves public health measures to control exposure to tobacco smoke, personal advice on smoking cessation and the use of appropriate targeted therapies, although evidence is limited on their effectiveness. Understanding the mechanisms, natural history and management of current and ex-smokers with asthma and smoking-induced airway disease without COPD is a priority for future research.

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A Novel Spirometric Measure Identifies Mild COPD Unidentified by Standard Criteria

Cited by 47 publications

References 60 publications

Smokers with respiratory symptoms but no airflow limitation, often have activity limitation, exacerbations and evidence of airway disease

Smokers with respiratory symptoms but no airflow limitation, often have activity limitation, exacerbations and evidence of airway disease

COPD beyond proximal bronchial obstruction: phenotyping and related tools at the bedside

Asthma and smoking-induced airway disease without spirometric COPD

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