An official American Thoracic Society/European Respiratory Society statement: research questions in COPD

BACKGROUND Currently, the diagnosis of chronic obstructive pulmonary disease (COPD) requires a ratio of forced expiratory volume in 1 second (FEV1) to forced vital capacity (FVC) of less than 0.70 as assessed by spirometry after bronchodilator use. However, many smokers who do not meet this definition have respiratory symptoms. METHODS We conducted an observational study involving 2736 current or former smokers and controls who had never smoked and measured their respiratory symptoms using the COPD Assessment Test (CAT; scores range from 0 to 40, with higher scores indicating greater severity of symptoms). We examined whether current or former smokers who had preserved pulmonary function as assessed by spirometry (FEV1:FVC ≥0.70 and an FVC above the lower limit of the normal range after bronchodilator use) and had symptoms (CAT score, ≥10) had a higher risk of respiratory exacerbations than current or former smokers with preserved pulmonary function who were asymptomatic (CAT score, <10) and whether those with symptoms had different findings from the asymptomatic group with respect to the 6-minute walk distance, lung function, or high-resolution computed tomographic (HRCT) scan of the chest. RESULTS Respiratory symptoms were present in 50% of current or former smokers with preserved pulmonary function. The mean (±SD) rate of respiratory exacerbations among symptomatic current or former smokers was significantly higher than the rates among asymptomatic current or former smokers and among controls who never smoked (0.27± 0.67 vs. 0.08±0.31 and 0.03±0.21 events, respectively, per year; P<0.001 for both comparisons). Symptomatic current or former smokers, regardless of history of asthma, also had greater limitation of activity, slightly lower FEV1, FVC, and inspiratory capacity, and greater airway-wall thickening without emphysema according to HRCT than did asymptomatic current or former smokers. Among symptomatic current or former smokers, 42% used bronchodilators and 23% used inhaled glucocorticoids. CONCLUSIONS Although they do not meet the current criteria for COPD, symptomatic current or former smokers with preserved pulmonary function have exacerbations, activity limitation, and evidence of airway disease. They currently use a range of respiratory medications without any evidence base. (Funded by the National Heart, Lung, and Blood Institute and the Foundation for the National Institutes of Health; SPIROMICS ClinicalTrials.gov number, NCT01969344.)

show abstract

“…4 A recent task-force document emphasized the need for additional research involving smokers with symptoms and normal lung function. 5 …”

mentioning

confidence: 99%

Clinical Significance of Symptoms in Smokers with Preserved Pulmonary Function

et al. 2016

Self Cite

View full text Add to dashboard Cite

show abstract

“…We decide to present both AL GOLD and L LLN as a joint American Thoracic Society/European Respiratory Society (ATS/ERS) statement called for investigations of comparisons between the fixed cut-off (FEV 1 /FVC < 0.7) and the LLN-based definition (FEV 1 /FVC < LLN) of airflow limitation in predicting adverse health outcomes (Celli et al 2015). Our results also indicated that both definitions predicted an adverse outcome.…”

Section: Discussionmentioning

confidence: 76%

Lung function and paper dust exposure among workers in a soft tissue paper mill

Andersson

Sällsten

Lohman

et al. 2019

Int Arch Occup Environ Health

View full text Add to dashboard Cite

Purpose To study respiratory effects of exposure to soft paper dust exposure, a relationship that is rarely studied. Methods Soft tissue paper mill workers at a Swedish paper mill were investigated using a questionnaire and lung function and atopy screening. Spirometry without bronchodilation was performed with a dry wedge spirometer, and forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV 1) were obtained and expressed as percent predicted. Exposure to soft paper dust was assessed from historical stationary and personal measurements of total dust, in addition to historical information about the work, department, and production. The impact of high exposure to soft paper dust (> 5 mg/m 3) vs. lower exposure ≤ 5 mg/m 3 , as well as cumulative exposure, was analyzed using multiple linear regression models. Multivariate models were adjusted for smoking, atopy, gender, and body mass index. Results One hundred ninety-eight current workers (124 male and 74 female) were included. There were significant associations between both cumulative exposure and years of high exposure to soft paper dust and impaired lung function. Each year of high exposure to soft paper dust was associated with a 0.87% decrease in FEV 1 [95% confidence interval (CI) − 1.39 to − 0.35] and decreased FVC (− 0.54%, 95% CI − 1.00 to − 0.08) compared to the lower exposed workers. Conclusions The present study shows that occupational exposure to soft paper dust (years exceeding 5 mg/m 3 total dust) is associated with lung function impairment and increased prevalence of obstructive lung function impairment.

show abstract

“…We also assessed the effects of repeat PRP not only on exercise capacity changes, but also on quality of life and mood, as the importance of patient-centered outcomes in COPD is being increasingly recognized 27. We used mixed-effects modeling, which is the ideal approach for analysis of multiple repeated measurements in each patient, factoring in time between PRPs as a random effect 28.…”

Section: Discussionmentioning

confidence: 99%

Magnitude of exercise capacity and quality of life improvement following repeat pulmonary rehabilitation in patients with COPD

Sandoz

Roberts

Cho

et al. 2017

COPD

View full text Add to dashboard Cite

BackgroundMaintenance and repeated pulmonary rehabilitation programs (PRPs) for patients with COPD have attempted to prolong PRP benefits beyond 12–24 months. However, there is limited evidence as to the magnitude of benefit or the ideal interval between repeating the program under “real-world” conditions in which patients are referred based on clinical necessity. Therefore, we reviewed the effects of repeating PRP in a physician-referred cohort of patients with COPD.MethodsA total of 141 individuals with COPD completed PRP twice and 35 completed PRP three times over a 12-year period. We used linear mixed-effects models to quantify the magnitude and change in 6-minute walk distance (6MWD), St George’s Respiratory Questionnaire (SGRQ), and Hospital Anxiety and Depression Scale (HADS) for each PRP. One-way analysis of variance with Tukey’s post hoc analysis compared the effects of different time intervals on 6MWD, SGRQ, and HADS between PRPs.ResultsDespite 39 mL/year average decrease in forced expiratory volume in 1 second, overall 6MWD improved following each PRP (PRP1=58 m, P<0.0001; PRP2=42 m, P<0.0001; PRP3=32 m, P<0.003). Mean SGRQ decreased after PRP1 (−7.0 units; P<0.001) and PRP2 (−4.9 units; P<0.0001) but not after PRP3 (−3.2 units; P=0.10). HADS decreased after PRP1 (−1.9 units; P<0.0001) and PRP2 (−1.7 units; P=0.0001) but not after PRP3 (−0.4 units; P=0.63).ConclusionIn physician-referred patients who underwent repeat PRP as clinically required, there were clear benefits in functional exercise capacity following each repeat PRP, which was not affected by the time interval between PRPs. Health-related quality of life and mood improved after the first two PRPs, but not after a third.

show abstract

An official American Thoracic Society/European Respiratory Society statement: research questions in COPD

Cited by 89 publications

References 126 publications

Clinical Significance of Symptoms in Smokers with Preserved Pulmonary Function

Clinical Significance of Symptoms in Smokers with Preserved Pulmonary Function

Lung function and paper dust exposure among workers in a soft tissue paper mill

Magnitude of exercise capacity and quality of life improvement following repeat pulmonary rehabilitation in patients with COPD

Contact Info

Product

Resources

About