The many faces of COPD in real life: a longitudinal analysis of the NOVELTY cohort
Background The diagnosis of COPD requires the demonstration of non-fully reversible airflow limitation by spirometry in the appropriate clinical context. Yet, there are patients with symptoms and relevant exposures suggestive of COPD with either normal spirometry (pre-COPD) or preserved ratio but im...
| Main Authors: | , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
European Respiratory Society
2024-02-01
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| Series: | ERJ Open Research |
| Online Access: | http://openres.ersjournals.com/content/10/1/00895-2023.full |
| _version_ | 1797278821958811648 |
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| author | Alvar Agustí Rod Hughes Eleni Rapsomaki Barry Make Ricardo del Olmo Alberto Papi David Price Laura Benton Stefan Franzen Jørgen Vestbo Hana Mullerova |
| author_facet | Alvar Agustí Rod Hughes Eleni Rapsomaki Barry Make Ricardo del Olmo Alberto Papi David Price Laura Benton Stefan Franzen Jørgen Vestbo Hana Mullerova |
| author_sort | Alvar Agustí |
| collection | DOAJ |
| description | Background
The diagnosis of COPD requires the demonstration of non-fully reversible airflow limitation by spirometry in the appropriate clinical context. Yet, there are patients with symptoms and relevant exposures suggestive of COPD with either normal spirometry (pre-COPD) or preserved ratio but impaired spirometry (PRISm). Their prevalence, clinical characteristics and associated outcomes in a real-life setting are unclear.
Methods
To investigate them, we studied 3183 patients diagnosed with COPD by their attending physician included in the NOVELTY study (clinicaltrials.gov identifier NCT02760329), a global, 3-year, observational, real-life cohort that included patients recruited from both primary and specialist care clinics in 18 countries.
Results
We found that 1) approximately a quarter of patients diagnosed with (and treated for) COPD in real life did not fulfil the spirometric diagnostic criteria recommended by the Global Initiative for Chronic Obstructive Lung Disease (GOLD), and could be instead categorised as pre-COPD (13%) or PRISm (14%); 2) disease burden (symptoms and exacerbations) was highest in GOLD 3–4 patients (exacerbations per person-year (PPY) 0.82) and lower but similar in those in GOLD 1–2, pre-COPD and PRISm (exacerbations range 0.27–0.43 PPY); 3) lung function decline was highest in pre-COPD and GOLD 1–2, and much less pronounced in PRISm and GOLD 3-4; 4) PRISm and pre-COPD were not stable diagnostic categories and change substantially over time; and 5) all-cause mortality was highest in GOLD 3–4, lowest in pre-COPD, and intermediate and similar in GOLD 1–2 and PRISm.
Conclusions
Patients diagnosed COPD in a real-life clinical setting present great diversity in symptom burden, progression and survival, warranting medical attention. |
| first_indexed | 2024-03-07T16:14:45Z |
| format | Article |
| id | doaj.art-2ca139ec44a24bedaa71933a6852bffb |
| institution | Directory Open Access Journal |
| issn | 2312-0541 |
| language | English |
| last_indexed | 2024-03-07T16:14:45Z |
| publishDate | 2024-02-01 |
| publisher | European Respiratory Society |
| record_format | Article |
| series | ERJ Open Research |
| spelling | doaj.art-2ca139ec44a24bedaa71933a6852bffb2024-03-04T11:30:00ZengEuropean Respiratory SocietyERJ Open Research2312-05412024-02-0110110.1183/23120541.00895-202300895-2023The many faces of COPD in real life: a longitudinal analysis of the NOVELTY cohortAlvar Agustí0Rod Hughes1Eleni Rapsomaki2Barry Make3Ricardo del Olmo4Alberto Papi5David Price6Laura Benton7Stefan Franzen8Jørgen Vestbo9Hana Mullerova10 University of Barcelona, Respiratory Institute – Clinic Barcelona, IDIBAPS, and CIBERES, Barcelona, Spain Research and Early Development, Respiratory and Immunology, AstraZeneca, Cambridge, UK Research and Early Development, Respiratory and Immunology, AstraZeneca, Cambridge, UK National Jewish Health and University of Colorado Denver, Denver, CO, USA Diagnostic and Treatment Department, Hospital de Rehabilitaciόn Respiratoria “Maria Ferrer” and IDIM CR, Buenos Aires, Argentina University of Ferrara, Department of Translation Medicine, Ferrara, Italy Observational and Pragmatic Research Institute, Singapore and Centre of Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, UK Research and Early Development, Respiratory and Immunology, AstraZeneca, Cambridge, UK Research and Early Development, Respiratory and Immunology, AstraZeneca, Cambridge, UK University of Manchester and Manchester University NHS Foundation Trust, Manchester, UK Research and Early Development, Respiratory and Immunology, AstraZeneca, Cambridge, UK Background The diagnosis of COPD requires the demonstration of non-fully reversible airflow limitation by spirometry in the appropriate clinical context. Yet, there are patients with symptoms and relevant exposures suggestive of COPD with either normal spirometry (pre-COPD) or preserved ratio but impaired spirometry (PRISm). Their prevalence, clinical characteristics and associated outcomes in a real-life setting are unclear. Methods To investigate them, we studied 3183 patients diagnosed with COPD by their attending physician included in the NOVELTY study (clinicaltrials.gov identifier NCT02760329), a global, 3-year, observational, real-life cohort that included patients recruited from both primary and specialist care clinics in 18 countries. Results We found that 1) approximately a quarter of patients diagnosed with (and treated for) COPD in real life did not fulfil the spirometric diagnostic criteria recommended by the Global Initiative for Chronic Obstructive Lung Disease (GOLD), and could be instead categorised as pre-COPD (13%) or PRISm (14%); 2) disease burden (symptoms and exacerbations) was highest in GOLD 3–4 patients (exacerbations per person-year (PPY) 0.82) and lower but similar in those in GOLD 1–2, pre-COPD and PRISm (exacerbations range 0.27–0.43 PPY); 3) lung function decline was highest in pre-COPD and GOLD 1–2, and much less pronounced in PRISm and GOLD 3-4; 4) PRISm and pre-COPD were not stable diagnostic categories and change substantially over time; and 5) all-cause mortality was highest in GOLD 3–4, lowest in pre-COPD, and intermediate and similar in GOLD 1–2 and PRISm. Conclusions Patients diagnosed COPD in a real-life clinical setting present great diversity in symptom burden, progression and survival, warranting medical attention.http://openres.ersjournals.com/content/10/1/00895-2023.full |
| spellingShingle | Alvar Agustí Rod Hughes Eleni Rapsomaki Barry Make Ricardo del Olmo Alberto Papi David Price Laura Benton Stefan Franzen Jørgen Vestbo Hana Mullerova The many faces of COPD in real life: a longitudinal analysis of the NOVELTY cohort ERJ Open Research |
| title | The many faces of COPD in real life: a longitudinal analysis of the NOVELTY cohort |
| title_full | The many faces of COPD in real life: a longitudinal analysis of the NOVELTY cohort |
| title_fullStr | The many faces of COPD in real life: a longitudinal analysis of the NOVELTY cohort |
| title_full_unstemmed | The many faces of COPD in real life: a longitudinal analysis of the NOVELTY cohort |
| title_short | The many faces of COPD in real life: a longitudinal analysis of the NOVELTY cohort |
| title_sort | many faces of copd in real life a longitudinal analysis of the novelty cohort |
| url | http://openres.ersjournals.com/content/10/1/00895-2023.full |
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