Urgent call for studies in COPD patients aged 40-60 years

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 [1].

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 [2]. 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 [2]. 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 [2]. “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.

 

1. 1. Wedzicha W. Therapeutic trials in early COPD. Session A3, ATS 2020 Virtual, 5-10 Aug.
   2. Lange P, et al. N Engl J Med 2015:373:111-122.
   3. Anthonisen NR, et al. Am J Respir Crit Care Med 2002;166:675-679.
   4. Anthonisen NR, et al. Ann Intern Med 2005;142:233-239.

 

Posted on 29 October, 2020