Predictive value of lung function below the normal range and respiratory symptoms for progression of chronic obstructive pulmonary disease

Abstract

Background: Chronic obstructive pulmonary disease (COPD) is an insidiously starting disease. Early detection has high priority because of the possibility of early implementation of smoking cessation interventions. An evidence based model for case finding of COPD is not yet available. Objective: To describe the early development of COPD, and to assess the predictive value of early signs (respiratory symptoms, lung function below the normal range, reversibility). Design and methods: In a prospective study, based in general practice, formerly undiagnosed subjects (n = 464) were assessed at baseline and at 5 years for respiratory symptoms and pulmonary function. Odds ratios for early signs were calculated (adjusted for age, gender, pack-years at baseline and smoking behaviour during follow-up), and defined as possible indicators of disease progression. Results: Over a 5 year period, the percentage of subjects with obstruction increased from 7.5% (n = 35) at baseline to 24.8% (n = 115) at 5 years. The presence of mild early signs and lung function below the normal range at baseline were related to an increased risk of developing mild to moderate COPD (GOLD I: OR 1.87 (95% CI 1.22 to 2.87); GOLD II: OR 2.08 (95% CI 1.29 to 3.37) to 2.54 (95% CI 1.25 to 5.19)) at 5 years. Conclusion: Lung function below the normal range and early respiratory signs predict the development and progression of COPD.In the past decades, an increase in the prevalence of chronic obstructive pulmonary disease (COPD) and asthma has been observed.

Lung function decrement with arsenic exposure to drinking groundwater along River Indus: a comparative cross-sectional study

“…Studies have shown that lung function changes may be present well before the occurrence of well defined signs and symptoms of respiratory diseases (Ichinose et al 1993). Therefore, spirometry has been suggested to be used as a predictor for disease occurrence in future (Albers et al 2008;Dezateux et al 2001;Tager et al 1993;Taussig et al 2003;Turner et al 2004). The development of frank signs and symptoms of respiratory diseases due to continued exposure of arsenic is inevitable and is a predictor of future burden of respiratory diseases among the population.…”

Lung function decline in relation to diagnostic criteria for airflow obstruction in respiratory symptomatic subjects

“…Until now only few studies have looked at the course of clinical markers of COPD prognosis or outcome in relation to criteria for defining airflow obstruction. In a previous study from our group we have shown that in a primary care cohort of undiagnosed adults lung function below the normal range and early respiratory signs predicted the development and progression of COPD in the next five years [33]. Garcio-Rio and colleagues recently reported that subjects aged 40-80 who were 'over-diagnosed' with COPD by the fixed 0.70 ratio experienced worse quality of life compared to non-COPD subjects, but had similar exercise capacity and frequency of exacerbations [34].…”

Cough and sputum production as risk factors for poor outcomes in patients with COPD

“…11,13,14,16,47,49,50 Other risk factors that contribute to poor outcomes in COPD are summarised in Table 3. 11,16,47,49 The link between respiratory symptoms and exacerbations is probably the increased frequency of bacterial colonisation in patients with mucus hypersecretion. This colonisation will facilitate the conditions for exacerbations to develop.…”