Natural Histories of Chronic Obstructive Pulmonary Disease

Rennard, Stephen I.; Vestbo, Jørgen

doi:10.1513/pats.200804-035qc

Cited by 63 publications

(62 citation statements)

References 61 publications

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“…1). 22,25,26 This highlights the importance of tobacco cessation in the primary treatment of COPD. All at-risk patients need evaluation for COPD in the primary care setting with many diagnoses missed in this setting.…”

Section: Risk Factorsmentioning

confidence: 96%

Burden of chronic obstructive pulmonary disease: Healthcare costs and beyond

May

Li²

2015

allergy asthma proc

183

111

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Section: Risk Factorsmentioning

confidence: 96%

Burden of chronic obstructive pulmonary disease: Healthcare costs and beyond

May

Li²

2015

allergy asthma proc

183

111

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“…Although this is a useful unified definition, airflow limitation is a relatively crude measure of lung health, as the lung is redundant, and the GOLD COPD minimum criteria of FEV 1 / FVC less than 0.7 after bronchodilators occurs only after considerable abnormalities are present (38,42,(70)(71)(72)(73). It has long been recognized that the limitation of forced expiratory airflow observed in COPD can result from intrinsic disease of the airways (chronic bronchitis) and/or destruction of the alveoli (emphysema), with most affected individuals having some contribution of both airway and alveolar disease (2-4, 6, 17, 18).…”

Section: Early Detection Of Lung Destructionmentioning

confidence: 99%

Circulating Endothelial Microparticles as a Measure of Early Lung Destruction in Cigarette Smokers

Gordon

Gudi

Krause

et al. 2011

Am J Respir Crit Care Med

205

173

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Rationale: There is increasing evidence that emphysema is associated with primary loss of pulmonary capillary endothelium. Plasma levels of endothelial microparticles (EMPs), small vesicles released from activated or apoptotic endothelial cells, are elevated in vascularrelated disorders. Objectives: To evaluate whether plasma EMP levels are elevated in smokers with early lung destruction as assessed by normal spirometry but reduced diffusing capacity of the lung for carbon monoxide (DL CO ). Methods: Lung health was assessed by pulmonary function tests (PFTs: spirometry, total lung capacity, DL CO ) and chest X-ray; smoking status was assessed by urine nicotine and cotinine. EMP levels (CD42b 2 CD31 1 microparticles) were quantified as activated or apoptotic. The initial cohort (n 5 92) included healthy nonsmokers (normal PFTs), healthy smokers (normal PFTs), and smokers with early evidence of lung destruction (normal spirometry, low DL CO ). Two prospective cohorts were then tested: a group similar to the initial cohort and an HIV1 1 cohort. Measurements and Main Results: Healthy smokers had mildly increased levels of EMPs. Strikingly, 95% of smokers with normal spirometry, low DL CO had increased EMPs, with reduced CD62 1 / CD31 1 ratios (P , 10 24 ) and elevated CD42b 2 CD31 1 annexin V 1 EMPs (P , 10 24 ), suggesting derivation from endothelial apoptosis. Most elevated EMPs were angiotensin-converting enzyme positive, suggesting derivation from pulmonary capillaries. Both prospective cohorts confirmed the initial cohort data. Conclusions: Plasma EMPs with apoptotic characteristics are elevated in smokers with normal spirometry but reduced DL CO , consistent with the concept that emphysema is associated, in part, with capillary endothelium apoptosis, suggesting that the early development of emphysema might be monitored with plasma EMP levels.

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“…COPD is a major cause of morbidity and mortality [2,3]. A recent worldwide study indicated an overall prevalence of spirometry-confirmed COPD among middle-aged and elderly people of approximately 10% [4].…”

Section: Introductionmentioning

confidence: 99%

COPD prognosis in relation to diagnostic criteria for airflow obstruction in smokers

et al. 2013

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The aim of this study was to establish which cut-off point for the forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC) ratio (i.e. fixed 0.70 or lower limit of normal (LLN) cut-off point) best predicts accelerated lung function decline and exacerbations in middle-aged smokers.We performed secondary analyses on the Lung Health Study dataset. 4045 smokers aged 35-60 years with mild-to-moderate obstructive pulmonary disease were subdivided into categories based on presence or absence of obstruction according to both FEV1/FVC cut-off points. Post-bronchodilator FEV1 decline served as the primary outcome to compare subjects between the categories. 583 (14.4%) subjects were nonobstructed and 3230 (79.8%) subjects were obstructed according to both FEV1/FVC cut-off points. 173 (4.3%) subjects were obstructed according to the fixed cut-off point, but not according to the LLN cut-off point (''discordant'' subjects). Mean¡SE post-bronchodilator FEV1 decline was 41.8¡2.0 mL?year -1 in nonobstructed subjects, 43.8¡3.8 mL?year -1 in discordant subjects and 53.5¡0.9 mL?year -1 in obstructed subjects (p,0.001). Our study showed that FEV1 decline in subjects deemed obstructed according to a fixed criterion (FEV1/ FVC ,0.70), but non-obstructed by a sex-and age-specific criterion (LLN) closely resembles FEV1 decline in subjects designated as non-obstructed by both criteria. Sex and age should be taken into account when assessing airflow obstruction in middle-aged smokers. @ERSpublications Lower limit of normal cut-off best predicts accelerated lung function decline and exacerbation in middle-aged smokers

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Natural Histories of Chronic Obstructive Pulmonary Disease

Cited by 63 publications

References 61 publications

Burden of chronic obstructive pulmonary disease: Healthcare costs and beyond

Burden of chronic obstructive pulmonary disease: Healthcare costs and beyond

Circulating Endothelial Microparticles as a Measure of Early Lung Destruction in Cigarette Smokers

COPD prognosis in relation to diagnostic criteria for airflow obstruction in smokers

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