Early COPD: current evidence for diagnosis and management

Aishath Fazleen, Tom Wilkinson, Aishath Fazleen, Tom Wilkinson

Abstract

Chronic obstructive pulmonary disease (COPD) affects one-tenth of the world's population and has been identified as a major global unmet health need by the World Health Organisation, which predicts that within 10 years, COPD will become the third leading cause of death. Despite active research, there have been no recent major strides in terms of disease modifying treatment for COPD; smoking cessation remains the only intervention known to alter disease progression and improve mortality. As established COPD is a key driver of disease burden, earlier diagnosis coupled with disease-modifying intervention carries promise as a route to address this global health priority. The concept of early COPD is emerging as an area of focus for research and consideration of new treatment modalities, as it has been hypothesised that intervention at this stage may potentially halt or reverse the disease process. However, at present, a globally accepted criteria for defining early COPD does not exist. Several studies propose small airways disease as the earliest stage in the development of COPD, and this has been demonstrated to be a precursor to development of emphysema and to correlate with subsequent development of airflow obstruction. However, treatment strategies for early disease, which pre-date the development of airflow obstruction, remain uncertain. This review addresses the rationale and current evidence base for the diagnosis and treatment of early COPD and highlights the challenges of implementing trials and clinical pathways to address COPD earlier in the life course, particularly in the absence of a universally accepted definition of COPD.The reviews of this paper are available via the supplemental material section.

Keywords: COPD diagnosis; COPD management; chronic obstructive pulmonary disease; early COPD.

Conflict of interest statement

Conflict of interest statement: Aishath Fazleen has nothing to disclose. Tom Wilkinson reports personal fees from MyMHealth, grants from Innovate UK, grants from GSK, grants and personal fees from AstraZeneca, grants and personal fees from Synairgen, personal fees from BI, outside the submitted work.

Figures

Figure 1.
Figure 1.
Revised GOLD classification of COPD based on spirometry, symptom score, and exacerbation frequency. Reproduced with permission from Vogelmeier et al. CAT, COPD assessment test; COPD, chronic obstructive pulmonary disease; FEV1, forced expiratory volume in 1 s; FVC, forced vital capacity; GOLD, Global Initiative for Obstructive Lung Disease; mMRC, modified Medical Research Council.
Figure 2.
Figure 2.
FEV1 decline according to COPD stage. Reproduced with permission from Tantucci et al. COPD, chronic obstructive pulmonary disease; FEV1, forced expiratory volume in 1 s.

References

    1. Wedzicha JA, Wilkinson T. Impact of chronic obstructive pulmonary disease exacerbations on patients and payers. Proc Am Thorac Soc 2006; 3: 218–221.
    1. Mannino DM, Make BJ. Is it time to move beyond the “O” in early COPD? Eur Respir J 2015; 46: 1535–1537.
    1. Decramer M, Cooper CB. Treatment of COPD: the sooner the better? Thorax 2010; 65: 837–841.
    1. Tavares N, Jarrett N, Hunt K, et al. Palliative and end-of-life care conversations in COPD: a systematic literature review. ERJ Open Res 2017; 3: 00068-2016.
    1. Welte T, Vogelmeier C, Papi A. COPD: early diagnosis and treatment to slow disease progression. Int J Clin Pract 2015; 69: 336–349.
    1. Buist AS, McBurnie MA, Vollmer WM, et al. International variation in the prevalence of COPD (The BOLD Study): a population-based prevalence study. Lancet 2007; 370: 741–750.
    1. Haughney J, Gruffydd-Jones K, Roberts J, et al. The distribution of COPD in UK general practice using the new GOLD classification. Eur Respir J 2014; 43: 993–1002.
    1. Barrecheguren M, Gonzalez C, Miravitlles M. What have we learned from observational studies and clinical trials of mild to moderate COPD? Respir Res 2018; 19: 177.
    1. Agusti A, Celli B. Natural history of COPD: gaps and opportunities. ERJ Open Res 2017; 3: 00117-2017.
    1. Woodruff PG, Barr RG, Bleecker E, et al. Clinical significance of symptoms in smokers with preserved pulmonary function. N Engl J Med 2016; 374: 1811–1821.
    1. Singh D, D’Urzo AD, Donohue JF, et al. Weighing the evidence for pharmacological treatment interventions in mild COPD; a narrative perspective. Respir Res 2019; 20: 141.
    1. Rossi A, Butorac-Petanjek B, Chilosi M, et al. Chronic obstructive pulmonary disease with mild airflow limitation: current knowledge and proposal for future research - a consensus document from six scientific societies. Int J Chron Obstruct Pulmon Dis 2017; 12: 2593–2610.
    1. Ray E, Culliford D, Kruk H, et al. Specialist Respiratory outreach: a case-finding initiative for identifying undiagnosed COPD in primary care. Submitted to NPJ Prim Care Respir Med.
    1. Agusti A, Celli B. Avoiding confusion in COPD: from risk factors to phenotypes to measures of disease characterisation. Eur Respir J 2011; 38: 749–751.
    1. Rennard SI, Drummond MB. Early chronic obstructive pulmonary disease: definition, assessment, and prevention. Lancet 2015; 385: 1778–1788.
    1. Soriano JB, Polverino F, Cosio BG. What is early COPD and why is it important? Eur Respir J 2018; 52: 1801448.
    1. Sapey E, Bafadhel M, Bolton CE, et al. Building toolkits for COPD exacerbations: lessons from the past and present. Thorax 2019; 74: 898–905.
    1. Williams NP, Coombs NA, Johnson MJ, et al. Seasonality, risk factors and burden of community-acquired pneumonia in COPD patients: a population database study using linked health care records. Int J Chron Obstruct Pulmon Dis 2017; 12: 313–322.
    1. Kim VL, Coombs NA, Staples KJ, et al. Impact and associations of eosinophilic inflammation in COPD: analysis of the AERIS cohort. Eur Respir J 2017; 50: 1700853.
    1. Hurst JR, Wilkinson TMA, Perera WR, et al. Relationships among bacteria, upper airway, lower airway, and systemic inflammation in COPD. Chest 2005; 127: 1219–1226.
    1. Martinez FJ, Han MK, Allinson JP, et al. At the root: defining and halting progression of early chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2018; 197: 1540–1551.
    1. Siafakas N, Bizymi N, Mathioudakis A, et al. EARLY versus MILD chronic obstructive pulmonary disease (COPD). Respir Med 2018; 140: 127–131.
    1. McDonough JE, Yuan R, Suzuki M, et al. Small-airway obstruction and emphysema in chronic obstructive pulmonary disease. N Engl J Med 2011; 365: 1567–1575.
    1. Hogg JC, Pare PD, Hackett TL. The contribution of small airway obstruction to the pathogenesis of chronic obstructive pulmonary disease. Physiol Rev 2017; 97: 529–552.
    1. Singh D. Small airway disease in patients with chronic obstructive pulmonary disease. Tuberc Respir Dis (Seoul) 2017; 80: 317–324.
    1. Galban CJ, Han MK, Boes JL, et al. Computed tomography-based biomarker provides unique signature for diagnosis of COPD phenotypes and disease progression. Nat Med 2012; 18: 1711–1715.
    1. Allinson JP, Hardy R, Donaldson GC, et al. Combined impact of smoking and early-life exposures on adult lung function trajectories. Am J Respir Crit Care Med 2017; 196: 1021–1030.
    1. Harber P, Tashkin DP, Simmons M, et al. Effect of occupational exposures on decline of lung function in early chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2007; 176: 994–1000.
    1. Vogelmeier CF, Criner GJ, Martinez FJ, et al. Global strategy for the diagnosis, management, and prevention of chronic obstructive lung disease 2017 report: GOLD executive summary. Eur Respir J 2017; 49: 1700214.
    1. Tantucci C, Modina D. Lung function decline in COPD. Int J Chron Obstruct Pulmon Dis 2012; 7: 95–99.
    1. Bridevaux PO, Gerbase MW, Probst-Hensch NM, et al. Long-term decline in lung function, utilisation of care and quality of life in modified GOLD stage 1 COPD. Thorax 2008; 63: 768–774.
    1. Mannino DM, Doherty DE, Sonia Buist A. Global initiative on obstructive lung disease (GOLD) classification of lung disease and mortality: findings from the atherosclerosis risk in communities (ARIC) study. Respir Med 2006; 100: 115–122.
    1. Regan EA, Lynch DA, Curran-Everett D, et al. Clinical and Radiologic Disease in Smokers With Normal Spirometry. JAMA Intern Med 2015; 175: 1539–1549.
    1. Harvey BG, Strulovici-Barel Y, Kaner RJ, et al. Risk of COPD with obstruction in active smokers with normal spirometry and reduced diffusion capacity. Eur Respir J 2015; 46: 1589–1597.
    1. Frantz S, Nihlen U, Dencker M, et al. Impulse oscillometry may be of value in detecting early manifestations of COPD. Respir Med 2012; 106: 1116–1123.
    1. Lipworth BJ, Jabbal S. What can we learn about COPD from impulse oscillometry? Respir Med 2018; 139: 106–109.
    1. Ostridge K, Wilkinson TM. Present and future utility of computed tomography scanning in the assessment and management of COPD. Eur Respir J 2016; 48: 216–228.
    1. Ostridge K, Williams N, Kim V, et al. Relationship between pulmonary matrix metalloproteinases and quantitative CT markers of small airways disease and emphysema in COPD. Thorax 2016; 71: 126–132.
    1. Ostridge K, Williams N, Kim V, et al. Distinct emphysema subtypes defined by quantitative CT analysis are associated with specific pulmonary matrix metalloproteinases. Respir Res 2016; 17: 92.
    1. Csikesz NG, Gartman EJ. New developments in the assessment of COPD: early diagnosis is key. Int J Chron Obstruct Pulmon Dis 2014; 9: 277–286.
    1. Ostridge K, Gove K, Paas KHW, et al. Using novel computed tomography analysis to describe the contribution and distribution of emphysema and small airways disease in chronic obstructive pulmonary disease. Ann Am Thorac Soc 2018; 16: 990–997.
    1. Gove K, Wilkinson T, Jack S, et al. Systematic review of evidence for relationships between physiological and CT indices of small airways and clinical outcomes in COPD. Respir Med 2018; 139: 117–125.
    1. Bhatt SP, Soler X, Wang X, et al. Association between functional small airway disease and FEV1 decline in chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2016; 194: 178–184.
    1. Scanlon PCJ, Waller L. Smoking cessation and lung function in mild to moderate COPD: the lung health study. Am J Respir Crit Care Med 2000; 161: 381–390.
    1. Anthonisen NR, Connett JE, Murray RP. Smoking and lung function of lung health study participants after 11 years. Am J Respir Crit Care Med 2002; 166: 675–679.
    1. Anthonisen NR, Connett JE, Kiley JP, et al. Effects of smoking cessation and the use of an inhaled anticholinergic bronchodilator on the rate of decline of FEV1: the lung health study. JAMA Intern Med 1994; 272: 1497–1505.
    1. Morice AH, Celli B, Kesten S, et al. COPD in young patients: a pre-specified analysis of the four-year trial of tiotropium (UPLIFT). Respir Med 2010; 104: 1659–1667.
    1. Pauwels RA, Löfdahl CG, Laitinen LA, et al. Long-term treatment with inhaled budesonide in persons with mild chronic obstructive pulmonary disease who continue smoking. N Engl J Med 1999; 340: 1948–1953.
    1. van Grunsven P, Schermer T, Akkermans R, et al. Short- and long-term efficacy of fluticasone propionate in subjects with early signs and symptoms of chronic obstructive pulmonary disease. Results of the DIMCA study. Respir Med 2003; 97: 1303–1312.
    1. Wedzicha JA, Calverley PM, Rabe KF. Roflumilast: a review of its use in the treatment of COPD. Int J Chron Obstruct Pulmon Dis 2016; 11:81–90.
    1. Lipari M, Benipal H, Kale-Pradhan P. Roflumilast in the management of chronic obstructive pulmonary disease. Am J Health Syst Pharm 2013; 70: 2087–2095.
    1. Wilkinson T, Wedzicha JA. Strategies for Improving Outcomes of COPD Exacerbations. Int J Chron Obstruct Pulmon Dis 2006: 335–342.
    1. Wilkinson TM, Donaldson GC, Hurst JR, et al. Early therapy improves outcomes of exacerbations of chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2004; 169: 1298–1303.
    1. Seemungal TA, Wilkinson TM, Hurst JR, et al. Long-term erythromycin therapy is associated with decreased chronic obstructive pulmonary disease exacerbations. Am J Respir Crit Care Med 2008; 178: 1139–1147.
    1. Tse HN, Raiteri L, Wong KY, et al. High-dose N-acetylcysteine in stable COPD: the 1-year, double-blind, randomized, placebo-controlled HIACE study. Chest 2013; 144: 106–118.
    1. Cazzola M, Calzetta L, Page C, et al. Influence of N-acetylcysteine on chronic bronchitis or COPD exacerbations: a meta-analysis. Eur Respir Rev. 2015; 24: 451–461.
    1. Warson A, Spalluto CM, McCrae C, et al. Dynamics of IFN-β responses during respiratory viral infection. Insights for therapeutic strategies. Am J Respir Crit Care Med 2020; 201: 83–94.
    1. Bagga B, Cehelsky JE, Vaishnaw A, et al. Effect of preexisting serum and mucosal antibody on experimental respiratory syncytial virus (RSV) challenge and infection of adults. J Infect Dis 2015; 212: 1719–1725.
    1. Wedzicha JA. Role of viruses in exacerbations of chronic obstructive pulmonary disease. Proc Am Thorac Soc 2004; 1: 115–120.
    1. Pleguezuelos O, Robinson S, Fernandez A, et al. A synthetic influenza virus vaccine induces a cellular immune response that correlates with reduction in symptomatology and virus shedding in a randomized phase Ib live-virus challenge in humans. Clin Vaccine Immunol 2015; 22: 828–835.
    1. Sanei F, Wilkinson T. Influenza vaccination for patients with chronic obstructive pulmonary disease: understanding immunogenicity, efficacy and effectiveness. Ther Adv Respir Dis 2016; 10: 349–367.
    1. Wilkinson TMA, Schembri S, Brightling C, et al. Non-typeable Haemophilus influenzae protein vaccine in adults with COPD: a phase 2 clinical trial. Vaccine 2019; 37: 6102–6111.
    1. Donaldson GC, Wilkinson TM, Hurst JR, et al. Exacerbations and time spent outdoors in chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2005; 171: 446–452.
    1. Jacome C, Marques A. Pulmonary rehabilitation for mild COPD: a systematic review. Respir Care 2014; 59: 588–594.
    1. Montes de, Oca M, Loeb E, Torres SH, et al. Peripheral muscle alterations in non-COPD smokers. Chest 2008; 133: 13–18.
    1. Bourne S, DeVos R, North M, et al. Online versus face-to-face pulmonary rehabilitation for patients with chronic obstructive pulmonary disease: randomised controlled trial. BMJ Open 2017; 7: e014580.
    1. Hanson C, Rutten EP, Wouters EF, et al. Influence of diet and obesity on COPD development and outcomes. Int J Chron Obstruct Pulmon Dis 2014; 9: 723–733.
    1. Cao C, Wang R, Wang J, et al. Body mass index and mortality in chronic obstructive pulmonary disease: a meta-analysis. PLoS One 2012; 7: e43892.
    1. Lavie CJ, Ventura HO, Milani RV. The “obesity paradox”: is smoking/lung disease the explanation? Chest 2008; 134: 896–868.
    1. Landbo C, Prescott E, Lange P, et al. Prognostic value of nutritional status in chronic obstructive pulmonary disease. Am J Respir Crit Care Med 1999; 160: 1856–1861.
    1. Dahl M, Nordestgaard BG. Markers of early disease and prognosis in COPD. Int J Chron Obstruct Pulmon Dis 2009; 4: 157–167.
    1. Ilumets H, Rytilä P, Demedts I, et al. Matrix metalloproteinases -8, -9 and -12 in smokers and patients with stage 0 COPD. Int J Chron Obstruct Pulmon Dis 2007; 2: 369–379.
    1. Nakajima T, Nakamura H, Owen CA, et al. Plasma cathepsin s and cathepsin s/cystatin c ratios are potential biomarkers for COPD. Dis Markers 2016; 2016: 4093870.

Source: PubMed

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