The many faces of copd in real life: a longitudinal analysis of the novelty cohort

The diagnosis of Chronic Obstructive Pulmonary Disease (COPD) requires the demonstration of non-fully reversible airflow limitation by spirometry in the appropriate clinical context. Yet, there are patients with symptoms and relevant exposures suggestive of COPD with either normal spirometry (pre-COPD) or Preserved Ratio but Impaired Spirometry (PRISm). Their prevalence, clinical characteristics and associated outcomes in a real-life setting are unclear.To investigate them, we studied 3183 patients diagnosed of COPD by their attending physician included in the NOVELTY study (NCT02760329), a global, 3-year, observational, real-life cohort that included patients recruited from both primary and specialist care clinics in 18 countries.We found that:(1)about a quarter of patients diagnosed with (and treated for) COPD in real-life did not fulfil the spirometric diagnostic criteria recommended by GOLD, and could be instead categorized as pre-COPD (13%) or PRISm (14%);(2)disease burden (symptoms and exacerbations) was highest in GOLD 3–4 patients (exacerbations per person-year [PPY]: 0.82) and lower but similar in those in GOLD 1–2, pre-COPD and PRISm (exacerbations PPY range: 0.27-0.43);(3)lung function decline was highest in pre-COPD and GOLD 1–2, and much less pronounced in PRISm and GOLD 3-4;(4); PRISm and pre-COPD were not stable diagnostic categories and change substantially over time; and,(5)all-cause mortality was highest in GOLD 3–4, lowest in pre-COPD, and intermediate and similar in GOLD 1–2 and PRISm.Patients diagnosed COPD in a real-life clinical setting present great diversity in symptom burden, progression, and survival, warranting medical attention.