All roads lead to COPD… or not?

Traditionally, COPD has been understood to be a self-inflicted disease caused by tobacco smoking, occurring in old, “susceptible” males and characterised by an accelerated decline of lung function with age. Yet, our understanding of the pathogenesis of COPD has changed very significantly over the past few years and, as a result, it is now defined as a heterogeneous condition that results from gene (G)–environment (E) interactions occurring over the lifetime (T) of the individual (GETomics) that can damage the lungs and/or alter their normal development/ageing process. As a result of this new understanding, the Global Initiative for Chronic Obstructive Lung Disease (GOLD) recognises the existence of a pre-COPD condition that identifies “… individuals of any age, with respiratory symptoms and/or other detectable structural (e.g. emphysema) and/or functional abnormalities (e.g. hyperinflation, reduced lung diffusing capacity, or rapid [lung function] decline), in the absence of airflow obstruction on post-bronchodilator spirometry […]. These patients may (or not) develop persistent airflow obstruction (i.e. COPD) over time”. GOLD 2023 also recognises the category of PRISm (Preserved Ratio (hence no airflow obstruction) with Impaired Spirometry) which may (or may not) develop chronic airflow limitation (CAL) over time. Understanding better which pre-COPD patients eventually develop CAL (or PRISm) may allow earlier and more effective preventive and management interventions.

Autores: Àlvar Agustí y Rosa Faner.

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