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2017 ; 12
(ä): 2593-2610
Nephropedia Template TP
gab.com Text
Twit Text FOAVip
Twit Text #
English Wikipedia
Chronic obstructive pulmonary disease with mild airflow limitation: current
knowledge and proposal for future research - a consensus document from six
scientific societies
#MMPMID28919728
Rossi A
; Butorac-Petanjek B
; Chilosi M
; Cosío BG
; Flezar M
; Koulouris N
; Marin J
; Miculinic N
; Polese G
; Samar?ija M
; Skrgat S
; Vassilakopoulos T
; Vuki?-Dugac A
; Zakynthinos S
; Miravitlles M
Int J Chron Obstruct Pulmon Dis
2017[]; 12
(ä): 2593-2610
PMID28919728
show ga
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.