What Is Pre-COPD?

At least once a week, I check my sources for anything new regarding chronic obstructive pulmonary disease (COPD). Sometimes, this doesn't amount to much.

But sometimes, such as this morning, I come across something interesting that I'd like to share with you. What I discovered this morning is a new word: "pre-COPD."

So, what is "pre-COPD?" Let's look into it together and see what it means.

What is pre-COPD?

The GOLD guidelines now recommend that all people suspected of having COPD go through spirometry testing (a pulmonary function test (PFT). This is because spirometry is now considered the gold standard for diagnosing COPD.1

So, to get an official COPD diagnosis, one would have to have symptoms of COPD – breathing difficulties, coughing, excess mucus, and reduced exercise capacity – along with declining lung function as determined by spirometry testing.

The problem is that some people do well on their spirometry test but have normal results and, therefore, are not diagnosed with COPD. Instead, they may be diagnosed with pre-COPD with a recommendation that they quit smoking if they have not done so already. Those with pre-COPD are noted to be at risk for losing lung function, "but not all of them do.1

Hence, we have our new term "pre-COPD." It's when you have COPD symptoms, but your spirometry results are normal.

Apparently, this term is new to COPD researchers, too. It inspired researchers at the University of California San Francisco to conduct a study.

Pre-COPD research findings

It was a large study with more than 1,300 participants. These people shared a common thread as either current or former smokers, falling within the age bracket of 40 to 80 years. Notably, their spirometry results appeared entirely normal.2

Central to this study was the inclusion of a control group, distinct from the smoker participants. This control group consisted of people who never smoked and exhibited no signs of COPD, as shown by their normal spirometry results. The presence of a control group holds crucial importance as it allows for a meaningful comparison of outcomes.2

All of the participants had regular tests for checking COPD:2

  • Spirometry
  • A 6-minute walk
  • Symptom check
  • Lung CT scans

They did these tests every year for three to four years. Then they took a break for five years before doing all these tests again.2

The study lasted from 2010 to 2021. The results were striking, revealing that nearly half experienced continuous COPD symptoms. These included breathing difficulties, coughing, excess mucus, and reduced exercise capacity.2

How should we interpret this?

As noted above, I had never heard of the term “pre-COPD" before starting this study. I am sure I'm not alone in this discovery, highlighting the critical role of studies like this. They enlighten folks like me and other medical professionals, ensuring we know these nuances.

Studies like this inspired experts to add a section on pre-COPD in the updated GOLD guidelines. This includes the definition noted above, along with a reminder that, even though these people do not meet standards for a COPD diagnosis, they still deserve care and treatment. However, they add, "The challenge is that there is no evidence on what the best treatment is for these patients."1

This will likely prompt more research, raising new questions. Questions like "What are the underlying causes of pre-COPD?", "How can we prevent pre-COPD from progressing to COPD?" "What are the best strategies for diagnosing it?" and "What treatment suits them best?"

This study has highlighted the importance of early detection and intervention for pre-COPD. It spotlights the need for further research to understand this condition better and develop more effective treatments.

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