The majority of COPD studies assess older patients. To stop lung function decline early, studies including the age group of 40 to 60 years are urgently needed, advocated Prof. Wisia Wedzicha (Imperial College London, UK) in her lecture on therapeutic trials in early COPD .
A study assessing the lung-function trajectories leading to COPD found that a low FEV1 in early adulthood was associated with a high COPD incidence . Among the 657 participants with an FEV1 of less than 80% of the predicted value before 40 years of age, 174 (26%) had COPD after 22 years of observation . On the other hand, half of the patients that had COPD after 22 years of observation had a normal FEV1 before 40 years of age, and then experienced a rapid decline in FEV1 thereafter . “I think this is the most important patient group, were we have to intervene early,” argued Prof. Wedzicha. “The better the lung function, the greater will be the decline once you smoke,” she explained. Most COPD trials included patients that >60 years old. “We are interested in the age group between 40-60 years,” Prof. Wedzicha stated.
As she pointed out, one needs at least 2 lung function readings in a time period over 2 years to observe a rapid decline in lung function. Low lung function and rapid decline of 40 mL/year may help detect those smokers at highest risk for incident COPD and identify a subgroup of smokers that might benefit the most from intensive secondary preventative measures, such as smoking cessation strategies. This data is supported by the lung health study, where lung function decline was much lower in intermittent quitters compared with continuous smokers [3,4]. Participants that stopped smoking before the age of 30 had a similar decline in lung function to non-smokers.
Future studies should include younger patients, with a primary endpoint of at least 50% current smokers with post-bronchodilator FEV1. Study duration has to be at least 3 years to notice a possible impact of treatment. “We also need to develop novel endpoints. Forced oscillation would, for example, be an interesting candidate,” concluded Prof. Wedzicha.
- Wedzicha W. Therapeutic trials in early COPD. Session A3, ATS 2020 Virtual, 5-10 Aug.
- Lange P, et al. N Engl J Med 2015:373:111-122.
- Anthonisen NR, et al. Am J Respir Crit Care Med 2002;166:675-679.
- Anthonisen NR, et al. Ann Intern Med 2005;142:233-239.
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Table of Contents: ERS 2020
Letter from the Editor
ERS 2020 Highlights Podcast
COVID-19 and the Lung
COVID-19 infections: Bronchoscopy provides additional diagnostic certainty
COVID-19 vaccines: An ongoing race
COVID-19: What is the risk of reinfection?
COVID-19 App: The Dutch experience
Secondary pulmonary fibrosis: a possible long-term effect of severe COVID-19
COVID-19 survivors benefit from structured follow-up
Early pulmonary rehabilitation post-COVID-19 aids recovery
Asthma – What's New
Mild asthma: A fundamental change in management
Dupilumab shows long-term efficacy in asthma patients
Severe asthma: Oral corticosteroids maintenance therapy associated with toxicity
First-in-class tyrosine kinase inhibitor shows promise in severe asthma
Predicting individual effectiveness of biologics in severe asthma
IL-5 antagonist showed efficacy in chronic rhinosinusitis with nasal polyps
Treatment according to genotype: The future of asthma therapy?
COPD – The Beat Goes On
The role of chronic symptoms as early biomarkers of COPD development
Urgent call for studies in COPD patients aged 40-60 years
Nasal high-flow therapy: a novel treatment option for hypercapnic COPD patients
Exacerbation history is a reliable predictor of future exacerbations
Singing training effective as physical rehabilitation in COPD
Current prediction tools underestimate exacerbation risk of severe COPD patients
Exercise and Sleep: From Impaired Function to New Therapeutic Strategies
CPAP withdrawal has negative consequences for sleep apnoea patients
Physical activity improves AHI in sleep apnoea patients
The Tobacco Epidemic: From Vaping to Cannabis
Poly-use of nicotine products and cannabis: a deadly combination
E-cigarettes: A source of chronic lung inflammation
Social smoking: Do not underestimate the risks
Chronic Cough – State of the Art
LEAD study shows multiple phenotypes in many chronic cough patients
First-in-class P2X3 receptor antagonist shows promise for chronic cough treatment
Lung Cancer Detection
Lung cancer screening: Most patients not eligible 1-2 years prior to diagnosis
Biomarkers: a novel tool to improve lung nodule classification
Distinct changes in lung microbiome precede clinical diagnosis of lung cancer
Best of Posters
Smartphone-based cough detection helpful in predicting asthma deterioration
Reduced lung function associated with cognitive decline in the elderly
Longer hospital stay and fewer transplants for frail ILD patients