Abstract

Chronic obstructive lung disease (COPD) is responsible for substantial rates of mortality and economic burden, and is one of the most important public-health concerns. As the disease characteristics include irreversible airway obstruction and progressive lung function decline, there has been a great deal of interest in detection at the early stages of COPD during the “at risk” or undiagnosed preclinical stage to prevent the disease from progressing to the overt stage. Previous studies have used various definitions of early COPD, and the term mild COPD has also often been used. There has been a great deal of recent effort to establish a definition of early COPD, but comprehensive evaluation is still required, including identification of risk factors, various physiological and radiological tests, and clinical manifestations for diagnosis of early COPD, considering the heterogeneity of the disease. The treatment of early COPD should be considered from the perspective of prevention of disease progression and management of clinical deterioration. There has been a lack of studies on this topic as the definition of early COPD has been proposed only recently, and therefore further clinical studies are needed.

Highlights

  • Chronic obstructive pulmonary disease (COPD) is a major public-health issue affecting 328 million people [1] and is the third leading cause of mortality worldwide [2]

  • Lange et al analyzed data from three large cohort studies to investigate lung-function trajectories. They reported a mean forced expiratory volume in 1 s (FEV1) decline of 53 mL/year in those who initially had no airway obstruction and later developed COPD after 22 years of obstruction [17]. These results indicate that the threshold of 60 mL/year may omit some individuals with rapid decline who are at risk of future COPD

  • The results showed that high radiographically measured residual volume to total lung capacity (RV/TLC) was associated with rapid decline in FEV1/forced vital capacity (FVC) in smokers with normal spirometry, which may eventually progress to overt COPD

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Summary

Introduction

Chronic obstructive pulmonary disease (COPD) is a major public-health issue affecting 328 million people [1] and is the third leading cause of mortality worldwide [2]. The major pathophysiology of COPD is irreversible obstruction of the airway with progressive lung function decline, especially in patients with continuous exposure to risk factors such as cigarette smoke, biomass smoke exposure, and air pollution, lung-function trajectories have a milder course in some patients [4,5,6]. Early diagnosis of preclinical COPD may be crucial in patients with fixed obstruction on spirometry with no or only mild symptoms before they develop clinically important deterioration, such as decline in lung function, worsening of symptoms, or acute exacerbation [11,12,13]. The impact of the exacerbation rate on forced expiratory volume in 1 s (FEV1) decline is more profound in early COPD [58]

Definition
Identification of Risk Factors
Pulmonary Function Test and Other Physiological Tests
Imaging Studies
Clinical Features
Biomarkers of Disease Progression
Natural Course of Early COPD
Treatment of Early COPD
Treatment of Early-Onset COPD and Mild COPD
Findings
Conclusions
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