3 Key Takeaways
Plain English Summary- 01Core Finding
In CGPS, 10-year incidence was 1.5% in the low-risk, 9.3% in the intermediate-risk, 24% in the high-risk, and 42% in the very high-risk category.
- 02Study Evidence
Tested in a observational cohort study (n = 14,506) at the real-world cohort stage.
- 03Practical Meaning
Observational cohort findings reveal real-world links, though lifestyle or unmeasured factors cannot be fully ruled out without an RCT.
What This Means for You
The pre-COPD score is useful in predicting the onset of COPD with clinically relevant discrimination in three cohorts with different risk profiles.
The Discovery
To test the hypothesis that development of COPD can be predicted by characterizing pre-COPD and creating a simple pre-COPD score. We identified individuals without airflow obstruction, defined as pre-bronchodilator (BD) forced expiratory volume in 1 second (FEV1)/forced vital capacity (FVC)≥0.70 and ≥lower limit of normal, from the Copenhagen General Population Study (CGPS)(N = 14,506), Copenhagen City Heart Study (CCHS)(N = 8673), and Genetic Epidemiology for COPD (COPDGene) Study(N = 2982). A pre-COPD score was developed in CGPS by assigning 1 point to each of smoking history≥10 pack-years, active smoking, any respiratory symptom, asthma, and pre-BD FEV1/FVC 0.70-0.75, and 4 points for pre-BD FEV1<a clinically meaningful level predicted, indicating presence of Preserved Ratio Impaired Spirometry (PRISm), with external validation in CCHS and COPDGene. Participants were followed for 5-10 years for incident COPD, defined as pre-BD FEV1/FVC<0.70 and FEV1<a clinically meaningful level predicted. During follow-up, COPD developed in 669 individuals (4.6%) in CGPS, 685 (7.9%) in CCHS, and 367 in COPDGene. In CGPS, 10-year incidence was a clinically meaningful level in the low-risk, a clinically meaningful level in the intermediate-risk, a clinically meaningful level in the high-risk, and a clinically meaningful level in the very high-risk category. Corresponding 5-year incidences were 3.7%, 7.3%, a clinically meaningful level, and 25% in CCHS, and 4.1%, 5.3%, 13%, and 31% in COPDGene, respectively. The pre-COPD score demonstrated good discrimination with areas under curve of 0.88 in CGPS, 0.76 in CCHS, and 0.81 in COPDGene. The pre-COPD score was also associated with exacerbations.
How It Works, Simply
This pulmonology research focuses on genetics. Researchers evaluated it using an observational cohort study (N = 14,506) at the real-world cohort stage of medical research.
3 Key Takeaways
Clinical Takeaways- 01Core Finding
In CGPS, 10-year incidence was 1.5% in the low-risk, 9.3% in the intermediate-risk, 24% in the high-risk, and 42% in the very high-risk category.
- 02Study Evidence
Tested in a observational cohort study (n = 14,506) at the real-world cohort stage.
- 03Practical Meaning
Observational cohort findings reveal real-world links, though lifestyle or unmeasured factors cannot be fully ruled out without an RCT.
Key Numbers
Biological Mechanism & Study Design
Study Design & Cohort
Observational cohort study
Observational cohort study (N = 14,506) · Real-World Cohort
Biological Pathway & Modality
Genetics
Intervention: Development and Validation of a Pre-COPD Score to Predict Incident COPD
Experimental Findings & Endpoints
To test the hypothesis that development of COPD can be predicted by characterizing pre-COPD and creating a simple pre-COPD score.
We identified individuals without airflow obstruction, defined as pre-bronchodilator (BD) forced expiratory volume in 1 second (FEV1)/forced vital capacity (FVC)≥0.70 and ≥lower limit of normal, from the Copenhagen General Population Study (CGPS)(N = 14,506), Copenhagen City Heart Study (CCHS)(N = 8673), and Genetic Epidemiology for COPD (COPDGene) Study(N = 2982). A pre-COPD score was developed in CGPS by assigning 1 point to each of smoking history≥10 pack-years, active smoking, any respiratory symptom, asthma, and pre-BD FEV1/FVC 0.70-0.75, and 4 points for pre-BD FEV1<a clinically meaningful level predicted, indicating presence of Preserved Ratio Impaired Spirometry (PRISm), with external validation in CCHS and COPDGene.
Participants were followed for 5-10 years for incident COPD, defined as pre-BD FEV1/FVC<0.70 and FEV1<a clinically meaningful level predicted. During follow-up, COPD developed in 669 individuals (4.6%) in CGPS, 685 (7.9%) in CCHS, and 367 in COPDGene.
In CGPS, 10-year incidence was a clinically meaningful level in the low-risk, a clinically meaningful level in the intermediate-risk, a clinically meaningful level in the high-risk, and a clinically meaningful level in the very high-risk category. Corresponding 5-year incidences were 3.7%, 7.3%, a clinically meaningful level, and 25% in CCHS, and 4.1%, 5.3%, 13%, and 31% in COPDGene, respectively.
The pre-COPD score demonstrated good discrimination with areas under curve of 0.88 in CGPS, 0.76 in CCHS, and 0.81 in COPDGene. The pre-COPD score was also associated with exacerbations.
Clinical Translation & Practice Context
The pre-COPD score is useful in predicting the onset of COPD with clinically relevant discrimination in three cohorts with different risk profiles.
The Bottom Line · Clinical Pearl
“The pre-COPD score is useful in predicting the onset of COPD with clinically relevant discrimination in three cohorts with different risk profiles.”
Published in American Journal of Respiratory and Critical Care Medicine · Current Stage: Real-World Cohort