• Katherine E Lowe, Elizabeth A Regan, Antonio Anzueto, Erin Austin, Austin John H M JHM Columbia University, New York., Terri H Beaty, Panayiotis V Benos, Christopher J Benway, Surya P Bhatt, Eugene R Bleecker, Sandeep Bodduluri, Jessica Bon, Aladin M Boriek, Adel Re Boueiz, Russell P Bowler, Matthew Budoff, Richard Casaburi, Peter J Castaldi, Jean-Paul Charbonnier, Michael H Cho, Alejandro Comellas, Douglas Conrad, Corinne Costa Davis, Gerard J Criner, Douglas Curran-Everett, Jeffrey L Curtis, Dawn L DeMeo, Alejandro A Diaz, Mark T Dransfield, Jennifer G Dy, Ashraf Fawzy, Margaret Fleming, Eric L Flenaugh, Marilyn G Foreman, Spyridon Fortis, Hirut Gebrekristos, Sarah Grant, Philippe A Grenier, Tian Gu, Abhya Gupta, MeiLan K Han, Nicola A Hanania, Nadia N Hansel, Lystra P Hayden, Craig P Hersh, Brian D Hobbs, Eric A Hoffman, James C Hogg, John E Hokanson, Karin F Hoth, Albert Hsiao, Stephen Humphries, Kathleen Jacobs, Francine L Jacobson, Ella A Kazerooni, Victor Kim, Woo Jin Kim, Gregory L Kinney, Harald Koegler, Sharon M Lutz, David A Lynch, Neil R MacIntye, Barry J Make, Nathaniel Marchetti, Fernando J Martinez, Diego J Maselli, Anne M Mathews, Meredith C McCormack, McDonald Merry-Lynn N MN University of Alabama at Birmingham., Charlene E McEvoy, Matthew Moll, Sarah S Molye, Susan Murray, Hrudaya Nath, John D Newell, Mariaelena Occhipinti, Matteo Paoletti, Trisha Parekh, Massimo Pistolesi, Katherine A Pratte, Nirupama Putcha, Margaret Ragland, Joseph M Reinhardt, Stephen I Rennard, Richard A Rosiello, James C Ross, Harry B Rossiter, Ingo Ruczinski, San Jose Estepar Raul R Brigham and Women's Hospital, Boston, Massachusetts., Frank C Sciurba, Jessica C Sieren, Harjinder Singh, Xavier Soler, Robert M Steiner, Matthew J Strand, William W Stringer, Ruth Tal-Singer, Byron Thomashow, Gonzalo Vegas Sánchez-Ferrero, John W Walsh, Emily S Wan, George R Washko, Michael Wells J J University of Alabama at Birmingham., Chris H Wendt, Gloria Westney, Ava Wilson, Robert A Wise, Andrew Yen, Kendra Young, Jeong Yun, Edwin K Silverman, and James D Crapo.
• Cleveland Clinic Lerner College of Medicine of Case Western Reserve School of Medicine, Cleveland, Ohio.
• Chronic Obstr Pulm Dis (Miami). 2019 Nov 1; 6 (5): 384-399.

BackgroundChronic obstructive pulmonary disease (COPD) remains a major cause of morbidity and mortality. Present-day diagnostic criteria are largely based solely on spirometric criteria. Accumulating evidence has identified a substantial number of individuals without spirometric evidence of COPD who suffer from respiratory symptoms and/or increased morbidity and mortality. There is a clear need for an expanded definition of COPD that is linked to physiologic, structural (computed tomography [CT]) and clinical evidence of disease. Using data from the COPD Genetic Epidemiology study (COPDGene®), we hypothesized that an integrated approach that includes environmental exposure, clinical symptoms, chest CT imaging and spirometry better defines disease and captures the likelihood of progression of respiratory obstruction and mortality.MethodsFour key disease characteristics - environmental exposure (cigarette smoking), clinical symptoms (dyspnea and/or chronic bronchitis), chest CT imaging abnormalities (emphysema, gas trapping and/or airway wall thickening), and abnormal spirometry - were evaluated in a group of 8784 current and former smokers who were participants in COPDGene® Phase 1. Using these 4 disease characteristics, 8 categories of participants were identified and evaluated for odds of spirometric disease progression (FEV1 > 350 ml loss over 5 years), and the hazard ratio for all-cause mortality was examined.ResultsUsing smokers without symptoms, CT imaging abnormalities or airflow obstruction as the reference population, individuals were classified as Possible COPD, Probable COPD and Definite COPD. Current Global initiative for obstructive Lung Disease (GOLD) criteria would diagnose 4062 (46%) of the 8784 study participants with COPD. The proposed COPDGene® 2019 diagnostic criteria would add an additional 3144 participants. Under the new criteria, 82% of the 8784 study participants would be diagnosed with Possible, Probable or Definite COPD. These COPD groups showed increased risk of disease progression and mortality. Mortality increased in patients as the number of their COPD characteristics increased, with a maximum hazard ratio for all cause-mortality of 5.18 (95% confidence interval [CI]: 4.15-6.48) in those with all 4 disease characteristics.ConclusionsA substantial portion of smokers with respiratory symptoms and imaging abnormalities do not manifest spirometric obstruction as defined by population normals. These individuals are at significant risk of death and spirometric disease progression. We propose to redefine the diagnosis of COPD through an integrated approach using environmental exposure, clinical symptoms, CT imaging and spirometric criteria. These expanded criteria offer the potential to stimulate both current and future interventions that could slow or halt disease progression in patients before disability or irreversible lung structural changes develop.JCOPDF © 2019.

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