Journal article
COPDGene® 2019: Redefining the Diagnosis of Chronic Obstructive Pulmonary Disease
Chronic obstructive pulmonary diseases, Vol.6(5), pp.384-399
11/2019
DOI: 10.15326/jcopdf.6.5.2019.0149
PMCID: PMC7020846
PMID: 31710793
Abstract
Background:
Chronic obstructive pulmonary disease (COPD) remains a major cause of morbidity and mortality. Present-day diagnostic criteria are largely based solely on spirometric criteria. Accumulating evidence has identified a substantial number of individuals without spirometric evidence of COPD who suffer from respiratory symptoms and/or increased morbidity and mortality. There is a clear need for an expanded definition of COPD that is linked to physiologic, structural (computed tomography [CT]) and clinical evidence of disease. Using data from the COPD Genetic Epidemiology study (COPDGene
®
), we hypothesized that an integrated approach that includes environmental exposure, clinical symptoms, chest CT imaging and spirometry better defines disease and captures the likelihood of progression of respiratory obstruction and mortality.
Methods:
Four key disease characteristics – environmental exposure (cigarette smoking), clinical symptoms (dyspnea and/or chronic bronchitis), chest CT imaging abnormalities (emphysema, gas trapping and/or airway wall thickening), and abnormal spirometry – were evaluated in a group of 8784 current and former smokers who were participants in COPDGene
®
Phase 1. Using these 4 disease characteristics, 8 categories of participants were identified and evaluated for odds of spirometric disease progression (FEV
1
> 350 ml loss over 5 years), and the hazard ratio for all-cause mortality was examined.
Results:
Using smokers without symptoms, CT imaging abnormalities or airflow obstruction as the reference population, individuals were classified as Possible COPD, Probable COPD and Definite COPD. Current Global initiative for obstructive Lung Disease (GOLD) criteria would diagnose 4062 (46%) of the 8784 study participants with COPD. The proposed COPDGene
®
2019 diagnostic criteria would add an additional 3144 participants. Under the new criteria, 82% of the 8784 study participants would be diagnosed with Possible, Probable or Definite COPD. These COPD groups showed increased risk of disease progression and mortality. Mortality increased in patients as the number of their COPD characteristics increased, with a maximum hazard ratio for all cause-mortality of 5.18 (95% confidence interval [CI]: 4.15–6.48) in those with all 4 disease characteristics.
Conclusions:
A substantial portion of smokers with respiratory symptoms and imaging abnormalities do not manifest spirometric obstruction as defined by population normals. These individuals are at significant risk of death and spirometric disease progression. We propose to redefine the diagnosis of COPD through an integrated approach using environmental exposure, clinical symptoms, CT imaging and spirometric criteria. These expanded criteria offer the potential to stimulate both current and future interventions that could slow or halt disease progression in patients before disability or irreversible lung structural changes develop.
Details
- Title: Subtitle
- COPDGene® 2019: Redefining the Diagnosis of Chronic Obstructive Pulmonary Disease
- Creators
- Katherine E Lowe - Cleveland Clinic Lerner College of Medicine of Case Western Reserve School of Medicine, Cleveland, OhioAlejandro Comellas - University of Iowa, Iowa CityElizabeth A Regan - National Jewish Health, Denver, ColoradoSpyridon Fortis - University of Iowa, Iowa CityAntonio Anzueto - University of Texas Health, San AntonioEric A Hoffman - University of Iowa, Iowa CityErin Austin - University of Colorado at DenverKarin F Hoth - University of Iowa, Iowa CityJohn H. M Austin - Columbia University, New York, New YorkJohn D Jr Newell - University of Iowa, Iowa CityTerri H Beaty - Johns Hopkins University, Baltimore, MarylandJoseph M Reinhardt - University of Iowa, Iowa CityPanayiotis V Benos - University of Pittsburgh, Pittsburgh, PennsylvaniaJessica C Sieren - University of Iowa, Iowa CityChristopher J Benway - Brigham and Women's Hospital, Boston, MassachusettsSurya P Bhatt - University of Alabama at BirminghamEugene R Bleecker - University of Arizona Health Sciences, TucsonSandeep Bodduluri - University of Alabama at BirminghamJessica Bon - University of Pittsburgh, Pittsburgh, PennsylvaniaAladin M Boriek - Baylor College of Medicine, Houston, TexasAdel RE Boueiz - Brigham and Women's Hospital, Boston, MassachusettsRussell P Bowler - National Jewish Health, Denver, ColoradoMatthew Budoff - Los Angeles Biomedical Research Institute at Harbor- University of California Los Angeles Medical Center, TorranceRichard Casaburi - Los Angeles Biomedical Research Institute at Harbor- University of California Los Angeles Medical Center, TorrancePeter J Castaldi - Brigham and Women's Hospital, Boston, MassachusettsJean-Paul Charbonnier - Thirona, Nijmegen, The NetherlandsMichael H Cho - Brigham and Women's Hospital, Boston, MassachusettsDouglas Conrad - University of California at San DiegoCorinne Costa Davis - COPD Foundation, Washington, DCGerard J Criner - Temple University, Philadelphia, PennsylvaniaDouglas Curran-Everett - National Jewish Health, Denver, ColoradoJeffrey L Curtis - Ann Arbor VA Medical Center, Ann Arbor, MichiganDawn L DeMeo - Brigham and Women's Hospital, Boston, MassachusettsAlejandro A Diaz - Brigham and Women's Hospital, Boston, MassachusettsMark T Dransfield - University of Alabama at BirminghamJennifer G Dy - Northeastern University, Boston, MassachusettsAshraf Fawzy - Johns Hopkins University, Baltimore, MarylandMargaret Fleming - Novartis Institute for Biomedical Research, Cambridge, MassachusettsEric L Flenaugh - Morehouse School of Medicine, Atlanta, GeorgiaMarilyn G Foreman - Morehouse School of Medicine, Atlanta, GeorgiaHirut Gebrekristos - Morehouse School of Medicine, Atlanta, GeorgiaSarah Grant - Novartis Institute for Biomedical Research, Cambridge, MassachusettsPhilippe A Grenier - Hôpital Foch, Suresnes, FranceTian Gu - University of Michigan, Ann ArborAbhya Gupta - Boehringer Ingelheim, Biberach an der Riss, GermanyMeiLan K Han - University of Michigan, Ann ArborNicola A Hanania - Baylor College of Medicine, Houston, TexasNadia N Hansel - Johns Hopkins University, Baltimore, MarylandLystra P Hayden - Brigham and Women's Hospital, Boston, MassachusettsCraig P Hersh - Brigham and Women's Hospital, Boston, MassachusettsBrian D Hobbs - Brigham and Women's Hospital, Boston, MassachusettsJames C Hogg - University of British Columbia, Vancouver, CanadaJohn E Hokanson - University of Colorado Anschutz Medical Campus, AuroraAlbert Hsiao - University of California-San Diego, La JollaStephen Humphries - National Jewish Health, Denver, ColoradoKathleen Jacobs - University of California at San DiegoFrancine L Jacobson - Brigham and Women's Hospital, Boston, MassachusettsElla A Kazerooni - University of Michigan, Ann ArborVictor Kim - Temple University, Philadelphia, PennsylvaniaWoo Jin Kim - Kangwon National University, Chuncheon, KoreaGregory L Kinney - University of Colorado Anschutz Medical Campus, AuroraHarald Koegler - Boehringer-Ingelheim, Ingelheim, GermanySharon M Lutz - Harvard Medical School, Boston, MassachusettsDavid A Lynch - National Jewish Health, Denver, ColoradoNeil R MacIntye Jr - Duke University Health, Durham, North CarolinaBarry J Make - National Jewish Health, Denver, ColoradoNathaniel Marchetti - Temple University, Philadelphia, PennsylvaniaFernando J Martinez - Weill-Cornell Medicine, New York, New YorkDiego J Maselli - University of Texas Health, San AntonioAnne M Mathews - Duke University Health, Durham, North CarolinaMeredith C McCormack - Johns Hopkins University, Baltimore, MarylandMerry-Lynn N McDonald - University of Alabama at BirminghamCharlene E McEvoy - Minnesota Health Partners, St. PaulMatthew Moll - Brigham and Women's Hospital, Boston, MassachusettsSarah S Molye - AstraZeneca, Denver, ColoradoSusan Murray - University of Michigan, Ann ArborHrudaya Nath - University of Alabama at BirminghamMariaelena Occhipinti - University of Florence, Florence, ItalyMatteo Paoletti - University of Florence, Florence, ItalyTrisha Parekh - University of Alabama at BirminghamMassimo Pistolesi - University of Florence, Florence, ItalyKatherine A Pratte - National Jewish Health, Denver, ColoradoNirupama Putcha - Johns Hopkins University, Baltimore, MarylandMargaret Ragland - University of Colorado Anschutz Medical Campus, AuroraStephen I Rennard - AstraZeneca, Cambridge, United KingdomRichard A Rosiello - Reliant Medical Group, Worcester, MassachusettsJames C Ross - Brigham and Women's Hospital, Boston, MassachusettsHarry B Rossiter - Los Angeles Biomedical Research Institute at Harbor- University of California Los Angeles Medical Center, TorranceIngo Ruczinski - Johns Hopkins University, Baltimore, MarylandRaul San Jose Estepar - Brigham and Women's Hospital, Boston, MassachusettsFrank C Sciurba - University of Pittsburgh, Pittsburgh, PennsylvaniaHarjinder Singh - University of Texas Health, San AntonioXavier Soler - University of California at San DiegoRobert M Steiner - Temple University, Philadelphia, PennsylvaniaMatthew J Strand - National Jewish Health, Denver, ColoradoWilliam W Stringer - Los Angeles Biomedical Research Institute at Harbor- University of California Los Angeles Medical Center, TorranceRuth Tal-Singer - GlaxoSmithKline, Collegeville, PennsylvaniaByron Thomashow - Columbia University, New York, New YorkGonzalo Vegas Sánchez-Ferrero - Brigham and Women's Hospital, Boston, MassachusettsJohn W Walsh - COPD Foundation, Miami, FloridaEmily S Wan - Brigham and Women's Hospital, Boston, MassachusettsGeorge R Washko - Brigham and Women's Hospital, Boston, MassachusettsJ Michael Wells - University of Alabama at BirminghamChris H Wendt - Minneapolis VA, Minneapolis, MinnesotaGloria Westney - Morehouse School of Medicine, Atlanta, GeorgiaAva Wilson - University of Alabama at BirminghamRobert A Wise - Johns Hopkins University, Baltimore, MarylandAndrew Yen - University of California at San DiegoKendra Young - University of Colorado Anschutz Medical Campus, AuroraJeong Yun - Brigham and Women's Hospital, Boston, MassachusettsEdwin K Silverman - Brigham and Women's Hospital, Boston, MassachusettsJames D Crapo - National Jewish Health, Denver, Colorado
- Resource Type
- Journal article
- Publication Details
- Chronic obstructive pulmonary diseases, Vol.6(5), pp.384-399
- Publisher
- COPD Foundation Inc; Miami, USA
- DOI
- 10.15326/jcopdf.6.5.2019.0149
- PMID
- 31710793
- PMCID
- PMC7020846
- ISSN
- 2372-952X
- eISSN
- 2372-952X
- Alternative title
- COPDGene® 2019: Redefining COPD Diagnosis
- Language
- English
- Date published
- 11/2019
- Academic Unit
- Roy J. Carver Department of Biomedical Engineering; Radiology; Pulmonary, Critical Care, and Occupational Medicine; Psychiatry; ICTS; Iowa Neuroscience Institute; Internal Medicine
- Record Identifier
- 9984066135502771
Metrics
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