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 Table of Contents  
Year : 2023  |  Volume : 3  |  Issue : 1  |  Page : 1-2

Prechronic obstructive pulmonary disease

Navaneeth, Sarovaram Biopark Road, Civil Station, Kozhikode - 673 020, Kerala, India

Date of Submission15-Nov-2022
Date of Acceptance17-Nov-2022
Date of Web Publication27-Dec-2022

Correspondence Address:
Dr. Ravindran Chetambath
Navaneeth, Sarovaram Biopark Road, Civil Station, Kozhikode - 673 020, Kerala
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jalh.jalh_36_22

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How to cite this article:
Chetambath R. Prechronic obstructive pulmonary disease. J Adv Lung Health 2023;3:1-2

How to cite this URL:
Chetambath R. Prechronic obstructive pulmonary disease. J Adv Lung Health [serial online] 2023 [cited 2023 Jun 11];3:1-2. Available from: https://www.jalh.org//text.asp?2023/3/1/1/365494

Prechronic obstructive pulmonary disease (pre-COPD) refers to a stage when individuals present with respiratory symptoms without spirometrically confirmed airway obstruction. This stage may eventually progress to airflow limitation consistent with a diagnosis of chronic obstructive pulmonary disease (COPD). Earlier there was an "at-risk" stage (GOLD stage 0), which was defined by the presence of risk factors (smoking) and symptoms (chronic cough and sputum production) in the absence of spirometric abnormalities that qualify for the diagnosis of COPD.[1] This category was not preferred by many clinicians stating that not all these individuals progress to COPD.[2] The diagnosis of COPD currently requires the demonstration of poorly reversible airflow limitation, defined as a post-bronchodilator forced expiratory volume in 1 s/forced vital capacity (FEV1/FVC) <0.7. It is observed that patients with a history of exposure to cigarette smoke or other environmental pollutants may have substantial lung pathology and respiratory impairment even in the absence of airflow limitation, as detected by spirometry. Not all of these patients will develop airflow limitation, but many will have considerable respiratory morbidity and a comparable prognosis to those with classical, spirometrically defined COPD. Identifying individuals who will eventually develop airflow obstruction consistent with a diagnosis of COPD at a stage when the FEV1/FVC value is >0.7, may enable therapeutic interventions with the potential to modify the course of the disease.

There is Step-1 asthma, which is intermittent asthma and for many years GINA guidelines proposed treatment with an as-needed short-acting beta agonist (SABA). Later, it was found out that SABA will not control underlying inflammation and most of these patients will develop persistent asthma due to airway remodeling. Now the treatment of Step-1 asthma is modified by adding anti-inflammatory agents. A similar situation can be proposed in COPD, wherein if we can formulate a strategy to arrest the progression of pathology, the development of overt COPD can be prevented. The clinical entity of respiratory bronchiolitis-interstitial lung disease (RB-ILD) which develop in smokers is predominantly a restrictive lung disease where FEV1/FEC will always be normal or above normal. The clinical spectrum of this disease has respiratory bronchiolitis, which is essentially small airway obstruction. The treatment suggested is avoidance of smoking and anti-inflammatory agents, preferably steroids. This is completely reversible. If not intervened at this stage, RB-ILD progresses to COPD with airflow limitation.

Pre-COPD relates to individuals of any age who have respiratory symptoms with or without structural and/or functional abnormalities, in the absence of airflow limitation, and who may develop persistent airflow limitation over time. Individuals with symptoms but without spirometrically defined obstruction compose a heterogeneous group, with some having dyspnea and others having chronic bronchitis. Some of these individuals may never develop spirometrically defined airflow obstruction, whereas others will experience rapid lung function decline and develop the overt disease.[3],[4] This new understanding of COPD provides novel opportunities for prevention, early diagnosis, and intervention.[5]

The term "pre-COPD" has been recently proposed to identify individuals of any age who have respiratory symptoms with/without structural and/or functional abnormalities, in the absence of airflow limitation (FEV1/FVC >0.7), and who may (or may not) develop persistent airflow limitation (i.e., COPD) over time.[6],[7] Individuals with pre-COPD are likely to demonstrate:

  1. Respiratory symptoms, including cough with sputum production
  2. Physiologic abnormalities, including low-normal FEV1, reduced Diffusion capacity for carbon monoxide (DLCO), and/or accelerated FEV1 decline
  3. Radiographic abnormalities, including airway abnormalities and emphysema.

This is an important stage, which gives a window of opportunity for the clinician as well as patients, to prevent an otherwise progressive, incurable disease with much morbidity and mortality. Considering the economic burden of treating COPD on the individual, family, and society, it is very important that every clinician should focus on identifying pre-COPD and intervene with appropriate steps to prevent progression to full-blown COPD. Such individuals should be on regular follow-ups undergoing spirometric evaluation, DLCO measurements, and imaging.

From the Editorial Desk of JALH

  References Top

Pauwels RA, Buist AS, Calverley PM, Jenkins CR, Hurd SS, GOLD Scientific Committee. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. NHLBI/WHO Global initiative for chronic obstructive lung disease (GOLD) workshop summary. Am J Respir Crit Care Med 2001;163:1256-76.  Back to cited text no. 1
Vestbo J, Lange P. Can GOLD stage 0 provide information of prognostic value in chronic obstructive pulmonary disease? Am J Respir Crit Care Med 2002;166:329-32.  Back to cited text no. 2
Lindberg A, Jonsson AC, Rönmark E, Lundgren R, Larsson LG, Lundbäck B. Ten-year cumulative incidence of COPD and risk factors for incident disease in a symptomatic cohort. Chest 2005;127:1544-52.  Back to cited text no. 3
Kalhan R, Dransfield MT, Colangelo LA, Cuttica MJ, Jacobs DR Jr., Thyagarajan B, et al. Respiratory symptoms in young adults and future lung disease. The CARDIA lung study. Am J Respir Crit Care Med 2018;197:1616-24.  Back to cited text no. 4
Agust&#!237; A, Hogg JC. Update on the pathogenesis of chronic obstructive pulmonary disease. N Engl J Med 2019;381:1248-56.  Back to cited text no. 5
Celli BR, Agustí A. COPD: Time to improve its taxonomy? ERJ Open Res 2018;4:00132-2017.  Back to cited text no. 6
Regan EA, Lynch DA, Curran-Everett D, Curtis JL, Austin JH, Grenier PA, et al. Clinical and radiologic disease in smokers with normal spirometry. JAMA Intern Med 2015;175:1539-49.  Back to cited text no. 7


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