Alvar Agusti, Rosa Faner
European Respiratory Journal 2023 62: 2301470; DOI: 10.1183/13993003.01470-2023
Extract
Traditionally, COPD has been understood to be a self-inflicted disease caused by tobacco smoking, occurring in old, “susceptible” males and characterised by an accelerated decline of lung function with age [1, 2]. Yet, our understanding of the pathogenesis of COPD has changed very significantly over the past few years [3–6] and, as a result, it is now defined as a heterogeneous condition that results from gene (G)–environment (E) interactions occurring over the lifetime (T) of the individual (GETomics) that can damage the lungs and/or alter their normal development/ageing process [7]. As a result of this new understanding, the Global Initiative for Chronic Obstructive Lung Disease (GOLD) recognises the existence of a pre-COPD condition that identifies “… individuals of any age, with respiratory symptoms and/or other detectable structural (e.g. emphysema) and/or functional abnormalities (e.g. hyperinflation, reduced lung diffusing capacity, or rapid [lung function] decline), in the absence of airflow obstruction on post-bronchodilator spirometry […]. These patients may (or not) develop persistent airflow obstruction (i.e. COPD) over time” [7]. GOLD 2023 also recognises the category of PRISm (Preserved Ratio (hence no airflow obstruction) with Impaired Spirometry) [8] which may (or may not) develop chronic airflow limitation (CAL) over time [7]. Understanding better which pre-COPD patients eventually develop CAL (or PRISm) may allow earlier and more effective preventive and management interventions [9–12].
M.J. Divo and co-workers have developed and validated a Simple, Low cost and easy to IMplement (SLIM) calculator of the risk of developing incident chronic airflow limitation in middle-aged, ever-smokers with normal spirometry https://bit.ly/3sOqtaU
Footnotes
-
Conflict of interest: A. Agusti reports grants (paid to institution) from GSK and AstraZeneca, consulting fees from GSK, AstraZeneca, Chiesi, Menarini and Sanofi, payment or honoraria for lectures, presentations, manuscript writing or educational events from GSK, AstraZeneca, Chiesi, Menarini and Zambon, and is the chair of the board of directors of GOLD (unpaid). R. Faner reports grants from GSK, Menarini, AstraZeneca and Chiesi, consulting fees from AstraZeneca, and payment or honoraria for lectures, presentations, manuscript writing or educational events from AstraZeneca, Chiesi and Menarini.
-
Support statement: This work was supported, in part, by ISC-iii-FEDER (PI18/1008, PI21/00735, PMP21/00090), the European Research Council (ERC, PredictCOPD, 101044387), SEPAR, Menarini and the Serra Hunter programme.
- Received August 31, 2023.
- Accepted September 5, 2023.
- Copyright ©The authors 2023. For reproduction rights and permissions contact permissions@ersnet.org
