Journal club

Abstract

Chronic obstructive pulmonary disease (COPD) may originate in early life. Some individuals without airflow limitation, but with respiratory symptoms, or physiologic and radiologic abnormalities may be at risk of developing COPD later. Çolak et al (Am J Respir Crit Care Med. 2024;210(5):607–617. doi:10.1164/rccm.202308–1452OC) studied two large Danish population-based cohorts with up to 25 years of follow-up. They developed a COPD susceptibility score based on symptoms, smoking history, spirometry and medical history. After 10 years, 28% of individuals of those deemed susceptible developed COPD compared with 8% in those not deemed susceptible. At 25 years, 22%–26% of those deemed susceptible developed COPD, and 20% progressed to GOLD stage 2–4. Over half of those with COPD at final examination developed from a susceptible state. The COPD risk score gave a stepwise increased risk for COPD and was a better predictor than smoking alone. The results demonstrate a potential ‘pre-COPD state’, which could be used for identification of at-risk individuals. The existence of this state could be used to predict and prevent COPD in those at high risk. Inhaled corticosteroids (ICS) are a mainstay of asthma treatment and recommendations are to prescribe at the lowest possible …