10 pack-years of smoking: not the magic number for COPD risk and prognosis

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Threshold values play a critical role in clinical medicine, as they provide standardised criteria for diagnosis and treatment, ensuring consistency across different healthcare providers and settings. They help in maintaining uniformity in patient care, making sure that patients with similar characteristics receive similar evaluations and interventions. They also aid in risk stratification, allowing for targeted interventions for high-risk individuals, thereby optimising resource allocation and improving outcomes. For instance, lung function thresholds can help identify patients at risk for COPD and initiate appropriate management, such as help with smoking cessation [1]. And on the topic of thresholds and smoking, in many clinical settings across the globe, a COPD diagnosis is mainly considered in individuals with more than 10 or even 20 pack-years of smoking history, and randomised controlled trials of COPD patients most often use the 10 pack-year threshold as an inclusion criterion [2]. Tobacco use is indeed the single most preventable cause of both death and disease [3], but this 10 pack-years of smoking threshold with regards to COPD risk is, however, mainly based on tradition and not so much on solid scientific evidence.