Chronic obstructive pulmonary disease with mild airflow limitation: Current knowledge and proposal for future research – A consensus document from six scientific societies
Rossi, A. ; Butorac-Petanjek, B. ; Chilosi, M. ; Cosío, B.G. ; Flezar, M. ; Koulouris, N. ; Marin, J. (Universidad de Zaragoza) ; Miculinic, N. ; Polese, G. ; Samaržija, M. ; Skrgat, S. ; Vassilakopoulos, T. ; Vukic-Dugac, A. ; Zakynthinos, S. ; Miravitlles, M.
Resumen: Chronic obstructive pulmonary disease (COPD) is a leading cause of mortality and morbidity worldwide, with high and growing prevalence. Its underdiagnosis and hence under-treatment is a general feature across all countries. This is particularly true for the mild or early stages of the disease, when symptoms do not yet interfere with daily living activities and both patients and doctors are likely to underestimate the presence of the disease. A diagnosis of COPD requires spirometry in subjects with a history of exposure to known risk factors and symptoms. Postbronchodilator forced expiratory volume in 1 second (FEV1)/forced vital capacity <0.7 or less than the lower limit of normal confirms the presence of airflow limitation, the severity of which can be measured by FEV1% predicted: stage 1 defines COPD with mild airflow limitation, which means postbronchodilator FEV1 =80% predicted. In recent years, an elegant series of studies has shown that “exclusive reliance on spirometry, in patients with mild airflow limitation, may result in underestimation of clinically important physiologic impairment”. In fact, exercise tolerance, diffusing capacity, and gas exchange can be impaired in subjects at a mild stage of airflow limitation. Furthermore, growing evidence indicates that smokers without overt abnormal spirometry have respiratory symptoms and undergo therapy. This is an essential issue in COPD. In fact, on one hand, airflow limitation, even mild, can unduly limit the patient’s physical activity, with deleterious consequences on quality of life and even survival; on the other hand, particularly in younger subjects, mild airflow limitation might coincide with the early stage of the disease. Therefore, we thought that it was worthwhile to analyze further and discuss this stage of “mild COPD”. To this end, representatives of scientific societies from five European countries have met and developed this document to stimulate the attention of the scientific community on COPD with “mild” airflow limitation. The aim of this document is to highlight some key features of this important concept and help the practicing physician to understand better what is behind “mild” COPD. Future research should address two major issues: first, whether mild airflow limitation represents an early stage of COPD and what the mechanisms underlying the evolution to more severe stages of the disease are; and second, not far removed from the first, whether regular treatment should be considered for COPD patients with mild airflow limitation, either to prevent progression of the disease or to encourage and improve physical activity or both.
Idioma: Inglés
DOI: 10.2147/COPD.S132236
Año: 2017
Publicado en: International journal of chronic obstructive pulmonary disease 12 (2017), 2593-2610
ISSN: 1176-9106
Factor impacto JCR: 2.917 (2017)
Categ. JCR: RESPIRATORY SYSTEM rank: 25 / 59 = 0.424 (2017) - Q2 - T2
Factor impacto SCIMAGO: 1.395 - Health Policy (Q1) - Pulmonary and Respiratory Medicine (Q1) - Public Health, Environmental and Occupational Health (Q1) - Medicine (miscellaneous) (Q1)
Tipo y forma: Review (Published version)
Área (Departamento): Area Medicina (Dpto. Medicina, Psiqu. y Derm.)
You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use. You may not use the material for commercial purposes.
Exportado de SIDERAL (2019-07-09-11:53:37)
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Idioma: Inglés
DOI: 10.2147/COPD.S132236
Año: 2017
Publicado en: International journal of chronic obstructive pulmonary disease 12 (2017), 2593-2610
ISSN: 1176-9106
Factor impacto JCR: 2.917 (2017)
Categ. JCR: RESPIRATORY SYSTEM rank: 25 / 59 = 0.424 (2017) - Q2 - T2
Factor impacto SCIMAGO: 1.395 - Health Policy (Q1) - Pulmonary and Respiratory Medicine (Q1) - Public Health, Environmental and Occupational Health (Q1) - Medicine (miscellaneous) (Q1)
Tipo y forma: Review (Published version)
Área (Departamento): Area Medicina (Dpto. Medicina, Psiqu. y Derm.)
You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use. You may not use the material for commercial purposes. Exportado de SIDERAL (2019-07-09-11:53:37)
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Record created 2017-10-05, last modified 2019-07-09