Lung function trajectories an opportunity to predict COPD risk

COPD

By Selina Wellbelove

20 Oct 2022

Australian researchers have shown that tracking trajectories of lung function deficits from early age can help to predict the later development of COPD, potentially presenting a new opportunity for tackling related disease burden.

Looking at lung function in 2422 people aged 7 to 53 years of age, an international team of researchers led by Professor Shyamali Dharmage from the University of Melbourne found a strong association between obstructive and restrictive spirometry patterns and the development of COPD.

“If supported by other studies, our findings could inform development of clinical algorithms for detection of individuals who are at risk of developing COPD, and those with established yet undiagnosed COPD, to enable precision preventive and tailored management strategies,” the authors noted in a paper published in The Lancet Respiratory Medicine.

For the study, Prof Dharmage and colleagues characterised lifetime phenotypes of obstruction and restriction using data-driven techniques and life course spirometry measures of FEV1/FVC ratio and FVC, from early in life to middle age.

They found that the highest risk of developing COPD was in people with a mixed pattern, so both low FEV1/FVC ratio and low FVC trajectories (COPD prevalence 37% of 84 individuals), but that there was also a strong link between an obstructive-only pattern (low FEV1) and development of the disease (22% of 626 individuals).

“To our knowledge, this is the first study to characterise lifetime phenotypes of obstruction and restriction simultaneously using objective data-driven techniques and unique life course spirometry measures of FEV1/FVC ratio and FVC from childhood to middle age,” concluded the authors from the Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health.

“Mixed and obstructive-only patterns indicate those who might benefit from early COPD interventions. Those with the restrictive-only pattern had evidence of true lung restriction and were at increased risk of multimorbidity by middle age,” they added.

In a linked editorial, US pulmonologist Associate Professor Sonali Bose and colleagues said the findings suggested that identified obstruction, particularly severe obstruction, heralded critical disease progression by the sixth decade of life.

The research also showed that a restrictive-only pattern (low FVC only) identified those at increased risk of later multimorbidity, such as adult obesity, diabetes, cardiovascular conditions, hypertension and obstructive sleep apnoea.

Therefore, “clinicians should consider these spirometric patterns in young patients as potentially portending longterm consequences of disease, debilitation, and mortality”, the editorialists said.

The findings, they noted, add further ballast to the notion that early abnormalities in a seemingly healthy population “warrant risk modification at earlier points in the life course, opening the door even wider for opportunities to redirect abnormal lung health trajectories”.

This is particularly important given that the current clinical focus is on therapeutic strategies that come into play following a diagnosis, as opposed to a pro-active approach to preventing disease development through the reduction of early-like risks.

“Indeed, other than smoking cessation there are no well-established clinical or public health recommendations aimed at optimising lung health over the lifespan,” Dr Bose and colleagues point out.

“Further research is urgently needed to design prevention strategies for chronic lung disease during critical windows of susceptibility and set things back on track”, they noted.

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