TY - JOUR
T1 - Global initiative for chronic obstructive lung disease stage 0 is associated with excess FEV1 decline in a representative population sample
AU - Brito-Mutunayagam, Roshan
AU - Appleton, Sarah L.
AU - Wilson, David H.
AU - Ruffin, Richard E.
AU - Adams, Robert J.
N1 - Funding Information:
Financial/nonfinancial disclosures: The authors have reported to CHEST the following conflicts of interest: Drs Ruffin, Adams, and Wilson have received grant monies from the National Health and Medical Research Council (2007), and Queen Elizabeth Hospital Research Foundation (2009). Dr Adams received grant money in 2009 from the Australian Research Council. Dr Ruffin has been an expert witness for comment about a 1988 paper on combination therapy. GlaxoSmithKline donated 50 peak flow meters for research conducted in 2004; Adelaide University has received honoraria for presentations (GlaxoSmithKline [GSK]: 2004, 2005, and 2007) and expert witness testimony (GSK: 2008; Mundipharma: 2009) on behalf of Dr Ruffin. Dr Adams has received travel grants and speakers fees from GlaxoSmithKline (2007–2009). Mr Brito-Mutunayagam and Ms Appleton have reported that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.
Funding Information:
Funding/Support: This study was funded by the University of Adelaide and the South Australian Department of Health.
PY - 2010/9/1
Y1 - 2010/9/1
N2 - Background: The Global Initiative for Chronic Obstructive Lung Disease (GOLD) guideline removed stage 0 (chronic cough and sputum without airflow obstruction, GOLD-0) because of poor prognostic value. Preventative intervention may be relevant for those with chronic symptoms; therefore, we assessed the stability, morbidity, and FEV1 decline associated with GOLD stage 0 in a representative adult population cohort. Methods: Baseline (n = 4,060) and follow-up (n = 3,206, mean 3.5 years) clinic assessment of the North West Adelaide Health Study included postbronchodilator spirometry, anthropometry, and measures of doctor-diagnosed asthma, respiratory symptoms, smoking status, quality of life, and depression. Results: Baseline GOLD-0 prevalence was 17.0% (n = 584). At follow-up (n = 420), 39.8% remained stable, 1.4% progressed to GOLD stages 1 to 2, and 58.8% resolved to no symptoms. Persistent GOLD-0 at follow-up was associated with persistent smoking (men: odds ratio [OR] = 11.9, 95% CI, 6.4-22.1; women: OR = 4.0, 95% CI, 2.1-7.4), and depressive symptoms (men: OR = 3.8, 95% CI, 1.9-7.6; women: OR = 3.2, 95% CI, 1.7-5.9), with highest quartile of FEV1 decline (mL) per year (OR = 2.1, 95% CI, 1.2-3.7) and the metabolic syndrome (OR = 1.7, 95% CI, 1.01-3.0) in men, and with older age in women. These associations generally held in smokers and never-smokers. Resolving GOLD-0 was associated with smoking cessation (OR = 13.7; 95% CI, 4.6-40.1), FEV1 decline (mL) per year below the median (OR = 2.0; 95% CI, 1.1-3.5), normal BMI, and younger age groups. Sensitivity analyses based on the presence of sputum did not change the observed associations. Conclusion: Persistent GOLD-0 identified people with physical and psychologic morbidity in both smokers and nonsmokers. Identification of those with persistent respiratory symptoms is therefore important. Excess FEV1 decline in men suggests GOLD-0 may identify a group at risk to progress to COPD over time.
AB - Background: The Global Initiative for Chronic Obstructive Lung Disease (GOLD) guideline removed stage 0 (chronic cough and sputum without airflow obstruction, GOLD-0) because of poor prognostic value. Preventative intervention may be relevant for those with chronic symptoms; therefore, we assessed the stability, morbidity, and FEV1 decline associated with GOLD stage 0 in a representative adult population cohort. Methods: Baseline (n = 4,060) and follow-up (n = 3,206, mean 3.5 years) clinic assessment of the North West Adelaide Health Study included postbronchodilator spirometry, anthropometry, and measures of doctor-diagnosed asthma, respiratory symptoms, smoking status, quality of life, and depression. Results: Baseline GOLD-0 prevalence was 17.0% (n = 584). At follow-up (n = 420), 39.8% remained stable, 1.4% progressed to GOLD stages 1 to 2, and 58.8% resolved to no symptoms. Persistent GOLD-0 at follow-up was associated with persistent smoking (men: odds ratio [OR] = 11.9, 95% CI, 6.4-22.1; women: OR = 4.0, 95% CI, 2.1-7.4), and depressive symptoms (men: OR = 3.8, 95% CI, 1.9-7.6; women: OR = 3.2, 95% CI, 1.7-5.9), with highest quartile of FEV1 decline (mL) per year (OR = 2.1, 95% CI, 1.2-3.7) and the metabolic syndrome (OR = 1.7, 95% CI, 1.01-3.0) in men, and with older age in women. These associations generally held in smokers and never-smokers. Resolving GOLD-0 was associated with smoking cessation (OR = 13.7; 95% CI, 4.6-40.1), FEV1 decline (mL) per year below the median (OR = 2.0; 95% CI, 1.1-3.5), normal BMI, and younger age groups. Sensitivity analyses based on the presence of sputum did not change the observed associations. Conclusion: Persistent GOLD-0 identified people with physical and psychologic morbidity in both smokers and nonsmokers. Identification of those with persistent respiratory symptoms is therefore important. Excess FEV1 decline in men suggests GOLD-0 may identify a group at risk to progress to COPD over time.
UR - http://www.scopus.com/inward/record.url?scp=77956821892&partnerID=8YFLogxK
U2 - 10.1378/chest.09-2607
DO - 10.1378/chest.09-2607
M3 - Article
C2 - 20418365
AN - SCOPUS:77956821892
SN - 0012-3692
VL - 138
SP - 605
EP - 613
JO - Chest
JF - Chest
IS - 3
ER -