Weighing the Evidence for Pharmacological Treatment Interventions in Mild COPD; a Narrative Perspective

Overview

Journal Respir Res

Specialty Pulmonary Medicine

Date 2019 Jul 10

PMID 31286970

Citations 11

Authors

Dave Singh

Anthony D DUrzo

James F Donohue

Edward M Kerwin

Affiliations

Soon will be listed here.

Abstract

There is increasing focus on understanding the nature of chronic obstructive pulmonary disease (COPD) during the earlier stages. Mild COPD (Global Initiative for Chronic Obstructive Lung Disease [GOLD] stage 1 or the now-withdrawn GOLD stage 0) represents an early stage of COPD that may progress to more severe disease. This review summarises the disease burden of patients with mild COPD and discusses the evidence for treatment intervention in this subgroup.Overall, patients with mild COPD suffer a substantial disease burden that includes persistent or potentially debilitating symptoms, increased risk of exacerbations, increased healthcare utilisation, reduced exercise tolerance and physical activity, and a higher rate of lung function decline versus controls. However, the evidence for treatment efficacy in these patients is limited due to their frequent exclusion from clinical trials. Careful assessment of disease burden and the rate of disease progression in individual patients, rather than a reliance on spirometry data, may identify patients who could benefit from earlier treatment intervention.

Citing Articles

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References

Kanner R, Connett J, Williams D, Buist A . Effects of randomized assignment to a smoking cessation intervention and changes in smoking habits on respiratory symptoms in smokers with early chronic obstructive pulmonary disease: the Lung Health Study. Am J Med. 1999; 106(4):410-6. DOI: 10.1016/s0002-9343(99)00056-x. View

Pauwels R, Lofdahl C, Laitinen L, Schouten J, Postma D, Pride N . Long-term treatment with inhaled budesonide in persons with mild chronic obstructive pulmonary disease who continue smoking. European Respiratory Society Study on Chronic Obstructive Pulmonary Disease. N Engl J Med. 1999; 340(25):1948-53. DOI: 10.1056/NEJM199906243402503. View

Jones P, Willits L, Burge P, Calverley P . Disease severity and the effect of fluticasone propionate on chronic obstructive pulmonary disease exacerbations. Eur Respir J. 2003; 21(1):68-73. DOI: 10.1183/09031936.03.00013303. View

Mannino D, Buist A, Petty T, Enright P, Redd S . Lung function and mortality in the United States: data from the First National Health and Nutrition Examination Survey follow up study. Thorax. 2003; 58(5):388-93. PMC: 1746680. DOI: 10.1136/thorax.58.5.388. View

Wise R, Kanner R, Lindgren P, Connett J, Altose M, Enright P . The effect of smoking intervention and an inhaled bronchodilator on airways reactivity in COPD: the Lung Health Study. Chest. 2003; 124(2):449-58. DOI: 10.1378/chest.124.2.449. View

De Marco R, Accordini S, Cerveri I, Corsico A, Sunyer J, Neukirch F . An international survey of chronic obstructive pulmonary disease in young adults according to GOLD stages. Thorax. 2004; 59(2):120-5. PMC: 1746950. DOI: 10.1136/thorax.2003.011163. View

Gartlehner G, Hansen R, Carson S, Lohr K . Efficacy and safety of inhaled corticosteroids in patients with COPD: a systematic review and meta-analysis of health outcomes. Ann Fam Med. 2006; 4(3):253-62. PMC: 1479432. DOI: 10.1370/afm.517. View

Garcia-Aymerich J, Lange P, Benet M, Schnohr P, Anto J . Regular physical activity reduces hospital admission and mortality in chronic obstructive pulmonary disease: a population based cohort study. Thorax. 2006; 61(9):772-8. PMC: 2117100. DOI: 10.1136/thx.2006.060145. View

Stavem K, Sandvik L, Erikssen J . Can global initiative for Chronic Obstructive Lung Disease stage 0 provide prognostic information on long-term mortality in men?. Chest. 2006; 130(2):318-25. DOI: 10.1378/chest.130.2.318. View

10.

Reardon J, Lareau S, ZuWallack R . Functional status and quality of life in chronic obstructive pulmonary disease. Am J Med. 2006; 119(10 Suppl 1):32-7. DOI: 10.1016/j.amjmed.2006.08.005. View

11.

Travers J, Marsh S, Caldwell B, Williams M, Aldington S, Weatherall M . External validity of randomized controlled trials in COPD. Respir Med. 2006; 101(6):1313-20. DOI: 10.1016/j.rmed.2006.10.011. View

12.

Lofdahl C, Postma D, Pride N, BOE J, Thoren A . Possible protection by inhaled budesonide against ischaemic cardiac events in mild COPD. Eur Respir J. 2007; 29(6):1115-9. DOI: 10.1183/09031936.00128806. View

13.

Buist A, McBurnie M, Vollmer W, Gillespie S, Burney P, Mannino D . International variation in the prevalence of COPD (the BOLD Study): a population-based prevalence study. Lancet. 2007; 370(9589):741-50. DOI: 10.1016/S0140-6736(07)61377-4. View

14.

Stanojevic S, Wade A, Stocks J, Hankinson J, Coates A, Pan H . Reference ranges for spirometry across all ages: a new approach. Am J Respir Crit Care Med. 2007; 177(3):253-60. PMC: 2643211. DOI: 10.1164/rccm.200708-1248OC. View

15.

Ofir D, Laveneziana P, Webb K, Lam Y, ODonnell D . Mechanisms of dyspnea during cycle exercise in symptomatic patients with GOLD stage I chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2007; 177(6):622-9. DOI: 10.1164/rccm.200707-1064OC. View

16.

Bridevaux P, Gerbase M, Probst-Hensch N, Schindler C, Gaspoz J, Rochat T . Long-term decline in lung function, utilisation of care and quality of life in modified GOLD stage 1 COPD. Thorax. 2008; 63(9):768-74. DOI: 10.1136/thx.2007.093724. View

17.

Bale G, Martinez-Camblor P, Burge P, Soriano J . Long-term mortality follow-up of the ISOLDE participants: causes of death during 13 years after trial completion. Respir Med. 2008; 102(10):1468-72. DOI: 10.1016/j.rmed.2008.04.001. View

18.

Watz H, Waschki B, Meyer T, Magnussen H . Physical activity in patients with COPD. Eur Respir J. 2008; 33(2):262-72. DOI: 10.1183/09031936.00024608. View

19.

ODonnell D, Laveneziana P, Ora J, WEBB K, Lam Y, Ofir D . Evaluation of acute bronchodilator reversibility in patients with symptoms of GOLD stage I COPD. Thorax. 2008; 64(3):216-23. DOI: 10.1136/thx.2008.103598. View

20.

Jenkins C, Jones P, Calverley P, Celli B, Anderson J, Ferguson G . Efficacy of salmeterol/fluticasone propionate by GOLD stage of chronic obstructive pulmonary disease: analysis from the randomised, placebo-controlled TORCH study. Respir Res. 2009; 10:59. PMC: 2714501. DOI: 10.1186/1465-9921-10-59. View