Adopting the category of “pre-COPD” in GOLD recommendations would raise awareness, improve early intervention and boost research into how to modify or prevent disease progression, researchers have suggested.
In a review of current evidence, members of the GOLD (Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Lung Disease ) Science Committee said the concept of ‘GOLD 0’ had been abandoned because not all patients progressed to COPD, but in retrospect “this may not have been the best decision.”
The briefing paper – which is not an official GOLD document – suggests that a new, broader category of pre-COPD could be a way of identifying patients who do not have airflow obstruction detected by spirometry but have symptoms including cough with sputum production, or have spirometry readings on the lower side of normal or in decline, or radiographic abnormalities.
Writing in the American Journal of Respiratory and Critical Care Medicine, they said the concept of ‘pre’ disease status had been used in conditions such as diabetes and cancer and did not mean that all patients will go on to develop the disease but identifies those who may benefit from closer follow up and risk management.
“Our current definition of COPD based on FEV1/FVC ratio is highly specific for the disease we call COPD, but as the data we show here suggests, it is perhaps not sensitive to the breadth of abnormality we may see earlier in the disease process,” they said.
“We propose that the term ‘pre-COPD’ should be used to refer to individuals in whom spirometry is unable to detect airflow obstruction but who are at risk of subsequently developing COPD with a reduced FEV1/FVC ratio.”
They also pointed out that the subset of patients with chronic cough and phlegm were a specific group with a clear form of pre-COPD who experienced significant morbidity even if they never progressed to develop spirometric obstruction.
And while ultimately it would be helpful to develop a “tighter definition” of pre-COPD, the evidence on what this should be was lacking at the moment.
Speaking with the limbic, co-author Professor David Halpin, Consultant Physician and Honorary Professor of Respiratory Medicine at University of Exeter Medical School, said there had been lots of debate about how to define the group of people who are at risk for developing COPD but do not yet meet the criteria for spirometric airway obstruction.
He added that GOLD was unlikely to make any changes in the next year or two but they wanted to start a debate and get researchers working on how best to define this group.
“For practising clinicians there has always been this population that seem like they have COPD but don’t have spirometry and it prompts the question what do we do with them.”
Yet without defining this group it was hard to do the research on early intervention, he added.
“We need to identify patients that really are going to progress and if you can identify the high risk persons, you can research whether there are things you can do to reduce that risk.
“There may be interventions, such as inhaled therapies that can help them not progress.”