Abstract

ABSTRACT Background: Chronic obstructive pulmonary disease (COPD) is a largely underdiagnosed disease including several phenotypes. In this report, the design of a study intending to evaluate the pathophysiological mechanism in COPD in relation to the specific phenotypes non-rapid and rapid decline in lung function is described together with the recruitment process of the study population derived from a population based study. Method: The OLIN COPD study includes a population-based COPD cohort and referents without COPD identified in 2002–04 (n = 1986), and thereafter followed annually since 2005. Lung function decline was estimated from baseline in 2002–2004 to 2010 (first recruitment phase) or to 2012/2013 (second recruitment phase). Individuals who met the predefined criteria for the following four groups were identified; group A) COPD grade 2–3 with rapid decline in FEV1 and group B) COPD grade 2–3 without rapid decline in FEV1 (≥60 and ≤30 ml/year, respectively), group C) ever-smokers, and group D) non-smokers with normal lung function. Groups A–C included ever-smokers with >10 pack years. The intention was to recruit 15 subjects in each of the groups A-D. Results: From the database groups A–D were identified; group A n = 37, group B n = 29, group C n = 41, and group D n = 55. Fifteen subjects were recruited from groups C and D, while this goal was not reached in the groups A (n = 12) and B (n = 10). The most common reasons for excluding individuals identified as A or B were comorbidities contraindicating bronchoscopy, or inflammatory diseases/immune suppressive medication expected to affect the outcome. Conclusion: The study is expected to generate important results regarding pathophysiological mechanisms associated with rate of decline in lung function among subjects with COPD and the in-detail described recruitment process, including reasons for non-participation, is a strength when interpreting the results in forthcoming studies.

Highlights

  • Chronic obstructive pulmonary disease (COPD) is a largely underdiagnosed disease including several phenotypes

  • Actions for smoking control in the society have been followed by reduced smoking in many countries, and a recently published study indicates that the prevalence of COPD has decreased in parallel with changes in smoking habits in Sweden [3]

  • All subjects fulfilling the spirometric criteria for airway obstruction, FEV1/Vital capacity (VC)

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Summary

Introduction

Chronic obstructive pulmonary disease (COPD) is a largely underdiagnosed disease including several phenotypes. The design of a study intending to evaluate the pathophysiological mechanism in COPD in relation to the specific phenotypes non-rapid and rapid decline in lung function is described together with the recruitment process of the study population derived from a population based study. The results from studies including selected populations recruited from the health care (‘register-based studies’) must be interpreted with care, as the large underdiagnosis will affect generalizability. Most studies on COPD epidemiology are cross-sectional, limiting the understanding of the disease process from a general population point of view and, seldom include an evaluation of possible pathophysiological mechanisms in relation to disease progress

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