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Type: Journal article
Title: Global initiative for chronic obstructive lung disease stage 0 is associated with excess FEV₁ decline in a representative population sample
Other Titles: Global initiative for chronic obstructive lung disease stage 0 is associated with excess FEV(1) decline in a representative population sample
Author: Brito-Mutunayagam, R.
Appleton, S.
Wilson, D.
Ruffin, R.
Adams, R.
Citation: Chest, 2010; 138(3):605-613
Publisher: Amer Coll Chest Physicians
Issue Date: 2010
ISSN: 0012-3692
Statement of
Roshan Brito-Mutunayagam, Sarah L. Appleton, David H. Wilson, Richard E. Ruffin, and Robert J. Adams on behalf of the North West Adelaide Cohort Health Study Team
Abstract: Background: The Global Initiative for Chronic Obstructive Lung Disease (GOLD) guideline removed stage 0 (chronic cough and sputum without airflow obstruction, GOLD-0) because of poor prognostic value. Preventative intervention may be relevant for those with chronic symptoms; therefore, we assessed the stability, morbidity, and FEV1 decline associated with GOLD stage 0 in a representative adult population cohort. Methods: Baseline (n = 4,060) and follow-up (n = 3,206, mean 3.5 years) clinic assessment of the North West Adelaide Health Study included postbronchodilator spirometry, anthropometry, and measures of doctor-diagnosed asthma, respiratory symptoms, smoking status, quality of life, and depression. Results: Baseline GOLD-0 prevalence was 17.0% (n = 584). At follow-up (n = 420), 39.8% remained stable, 1.4% progressed to GOLD stages 1 to 2, and 58.8% resolved to no symptoms. Persistent GOLD-0 at follow-up was associated with persistent smoking (men: odds ratio [OR] = 11.9, 95% CI, 6.4-22.1; women: OR = 4.0, 95% CI, 2.1-7.4), and depressive symptoms (men: OR = 3.8, 95% CI, 1.9-7.6; women: OR = 3.2, 95% CI, 1.7-5.9), with highest quartile of FEV1 decline (mL) per year (OR = 2.1, 95% CI, 1.2-3.7) and the metabolic syndrome (OR = 1.7, 95% CI, 1.01-3.0) in men, and with older age in women. These associations generally held in smokers and never-smokers. Resolving GOLD-0 was associated with smoking cessation (OR = 13.7; 95% CI, 4.6-40.1), FEV1 decline (mL) per year below the median (OR = 2.0; 95% CI, 1.1-3.5), normal BMI, and younger age groups. Sensitivity analyses based on the presence of sputum did not change the observed associations. Conclusion: Persistent GOLD-0 identified people with physical and psychologic morbidity in both smokers and nonsmokers. Identification of those with persistent respiratory symptoms is therefore important. Excess FEV1 decline in men suggests GOLD-0 may identify a group at risk to progress to COPD over time.
Keywords: North West Adelaide Cohort Health Study Team; Humans; Pulmonary Disease, Chronic Obstructive; Forced Expiratory Volume; Prognosis; Severity of Illness Index; Risk Assessment; Cohort Studies; Predictive Value of Tests; Health Status; Quality of Life; Adult; Aged; Middle Aged; Female; Male
Rights: © 2010 American College of Chest Physicians
RMID: 0020101042
DOI: 10.1378/chest.09-2607
Appears in Collections:Medicine publications

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