COPD: New Concepts and Definitions

Researchers have proposed a novel definition for lung disease associated with smoke inhalation of different causes, as published in the Lancet.

Jose Baddini-Martinez, MD, PhD, and Adriana I de Pádua, MD, from the University of São Paulo in Brazil, have suggested a distinct concept—common smoke-related pulmonary disease (CSPD)—which would be defined as “a preventable and treatable disease, associated with an enhanced inflammatory response in the airways and the lungs to long-term exposure to noxious particles or gases. The disease can be characterized by clinical symptoms, radiological abnormalities, or persistent airflow limitation and it is usually progressive. Exacerbations and comorbidities contribute to the overall severity in individual patients.”

According to the researchers, exposure to biomass smoke in low-income countries may increase the incidence of chronic obstructive pulmonary disease (COPD). Also, other risk factors such as low socioeconomic status, aging, respiratory infections, and genetic markers have been associated with the condition.

Data from 2015 to 2016 show that a substantial number of cigarette smokers and ex-cigarette smokers can experience respiratory symptoms, impaired quality of life, and episodes of exacerbation despite normal spirometry results. These individuals can also display airway wall thickening and areas of emphysema on chest CT scans. The researchers stated that these patients cannot be defined as having COPD because the disease definition requires airflow limitation not completely reversible in spirometry.

CSPD would cover the definitions of COPD, chronic bronchitis, emphysema, and other terminologies such as obstructive chronic bronchitis or small airways disease. CSPD would also allow for incorporating future respiratory developments, considering genotypes and endotypes of the disease. 

Reference

1. Baddini-Martinez J, de Pdua AI. Chronic obstructive pulmonary disease: time to discuss new concepts. Lancet. 2016 Dec 3;388(10061):2740-2741. doi: 10.1016/S0140-6736(16)32424-2.

This article originally appeared on Clinical Advisor