Chronic obstructive pulmonary disease with mild airflow limitation: current knowledge and proposal for future research – a consensus document from six scientific societies

Abstract

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 (FEV ₁)/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 FEV ₁% predicted: stage 1 defines COPD with mild airflow limitation, which means postbronchodilator FEV ₁ ≥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.

Video abstract

Journal

Journal ID (nlm-ta): Int J Chron Obstruct Pulmon Dis

Journal ID (iso-abbrev): Int J Chron Obstruct Pulmon Dis

Journal ID (publisher-id): International Journal of COPD

Title: International Journal of Chronic Obstructive Pulmonary Disease

Publisher: Dove Medical Press

ISSN (Print): 1176-9106

ISSN (Electronic): 1178-2005

Publication date Collection: 2017

Publication date (Electronic): 29 August 2017

Volume: 12

Pages: 2593-2610

Affiliations

[1 ]Pulmonary Unit, University of Verona, Verona, Italy

[2 ]Respiratory Department, University Hospital Centre, Zagreb, Croatia

[3 ]Pathology Unit, University of Verona, Verona, Italy

[4 ]Department of Respiratory Medicine, Hospital Son Espases-IdISPa and CIBERES, Palma, Spain

[5 ]University Clinic of Respiratory and Allergic Diseases, Golnik, Slovenia

[6 ]First Department of Respiratory Medicine, Medical School of National and Kapodistrian University of Athens, Greece

[7 ]Respiratory Medicine, Hospital Universitario Miguel Servet, CIBERES & IISAragon, Zaragoza, Spain

[8 ]Pulmonary Unit, ULSS 22 Bussolengo, Italy

[9 ]Jordanovac Department for Respiratory Diseases, University of Zagreb School of Medicine, University Hospital Centre, Zagreb, Croatia

[10 ]First Department of Critical Care and Pulmonary Services, Evangelismos Hospital, University of Athens, Greece

[11 ]Pneumology Department, Hospital Universitary Vall d’Hebron, Barcelona, Spain

Author notes

Correspondence: Andrea Rossi, UOC Pneumologia, Azienda Ospedaliera-Universitaria Integrata, 1 Piazzale Stefani, Verona 37126, Italy, Tel [phone], Email andrea.rossi@ 123456aiporicerche.it

Article

Publisher ID: copd-12-2593

DOI: 10.2147/COPD.S132236

PMC ID: 5587130

Copyright statement: © 2017 Rossi et al. This work is published and licensed by Dove Medical Press Limited

License:

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Categories

Subject: Review