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Review
. 2015 May 2;385(9979):1778-1788.
doi: 10.1016/S0140-6736(15)60647-X.

Early chronic obstructive pulmonary disease: definition, assessment, and prevention

Stephen I Rennard  1 , M Bradley Drummond  2
Affiliations
Review

Early chronic obstructive pulmonary disease: definition, assessment, and prevention

Stephen I Rennard et al. Lancet. .

Abstract

Chronic obstructive pulmonary disease (COPD) is the third leading cause of death worldwide. COPD, however, is a heterogeneous collection of diseases with differing causes, pathogenic mechanisms, and physiological effects. Therefore a comprehensive approach to COPD prevention will need to address the complexity of COPD. Advances in the understanding of the natural history of COPD and the development of strategies to assess COPD in its early stages make prevention a reasonable, if ambitious, goal.

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Conflict of interest statement

Declaration of interests

Since 2012, SIR has received honoraria, consultation fees or research funding from the American Board of Internal Medicine, Almirall, APT Pharma, the American Thoracic Society, AstraZeneca, Baxter, Boerhinger Ingelheim, Chiesi, Cipla, the Cleveland Clinic, the COPD Foundation, CSA, CSL, the California Thoracic Society, Daiichi Sankyo, Elevation Pharma, Forest, GSK, Gilead, Johnson & Johnson, MedImmune, Novartis, Pearl, Pfizer, Pulmatrix, Regeneron, Takeda, Theron, the National Heart, Lung and Blood Institute, and the Nebraska Department of Health and Human Services. MBD has no relevant financial competing interests related to this Series paper. MBD has served as a consultant for Lupin Pharmaceuticals and has received institutional grant funding from the National Institutes of Health for studies related to COPD.

Figures

Figure 1
Figure 1. Effect of age on FEV1:FVC ratio and definition of chronic obstructive pulmonary disease
Diagram showing the loss of the lower limit of normal of FEV1:FVC ratio with ageing. The blue shaded portion represents elderly patients who are potentially overdiagnosed and the orange shaded portion represents younger adults who are potentially underdiagnosed with obstructive lung disease. FEV1=forced expiratory volume in 1 s. FVC=forced vital capacity. Reproduced from Mannino and colleagues, by permission of BMJ Publishing Group.
Figure 2
Figure 2. Subsets of chronic obstructive pulmonary disease
Chronic bronchitis, emphysema, and asthma can lead to fixed airflow limitation. The three disorders can overlap. All can be present without airflow limitation. This results in several (numbered) potential groups, which could be deemed subsets of chronic obstructive pulmonary disease and related disorders. Modified from Snider, by permission of the American Thoracic Society.
Figure 3
Figure 3. Natural history of lung function and development of chronic obstructive pulmonary disease
(A) Normal lung function natural history. (B) Reduced lung growth during fetal development, childhood, or adolescence (which might be independent), any of which can reduce attained lung function. (C) Shortened plateau. (D) Accelerated lung function loss during adulthood. (E) Episodic loss of lung function without full recovery. (F) Late accelerated loss of lung function. FEV1=forced expiratory volume in 1 s. *Presence of early disease for each disease natural history.
See this image and copyright information in PMC

References

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MeSH terms