COPD

Pre-COPD newly featured in the 2023 GOLD report


The concept of ‘Pre-COPD’ has been defined for the first time in the latest iteration of the GOLD recommendations, potentially paving the way for new opportunities for disease prevention, diagnosis and intervention.

The 2023 report describes pre-COPD as the presence of structural lung lesions and/or physiological abnormalities (such as low to normal FEV1, gas trapping, hyperinflation, reduced lung diffusing capacity and/or a rapid drop in FEV1) in individuals without airflow obstruction.

It has also defined the term ‘PRISm’ (Preserved Ratio Impaired Spirometry) as patients with a normal ratio of FEV1/FVC (≥ 0.7 after bronchodilation) but abnormal spirometry (FEV1 and/or FVC < 80% of reference, after bronchodilation).

People with Pre-COPD or PRISm “are at risk of developing airflow obstruction over time, but not all of them do”, but should still be viewed as patients “because they already suffer symptoms and/or have functional and/or structural abnormalities”, according to the report.

“The realisation that environmental factors other than tobacco smoking can contribute to COPD, that it can start early in life and affect young individuals, and that there are precursor conditions (Pre-COPD, PRISm), opens new windows of opportunity for its prevention, early diagnosis, and prompt and appropriate therapeutic intervention,” it noted.

Other key highlights include important updates to assessment algorithms and treatment algorithms, assessment of exacerbations, a new section on chronic bronchitis, updated vaccination recommendations for people with COPD, expanded information on treatments to reduce COPD mortality, a new section on tele rehabilitation and information on adherence to COPD medicines.

Speaking to the limbic at the British Thoracic Society meeting in London, Professor David Halpin outlines the key changes in the 2023 GOLD report.

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