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Disease progression in young patients with COPD: rethinking the Fletcher and Peto model

Pablo Sanchez-Salcedo, Miguel Divo, Ciro Casanova, Victor Pinto-Plata, Juan P. de-Torres, Claudia Cote, Carlos Cabrera, Jorge Zagaceta, Roberto Rodriguez-Roisin, Javier J. Zulueta, Jose Maria Marin, Bartolome Celli
European Respiratory Journal 2014; DOI: 10.1183/09031936.00208613
Pablo Sanchez-Salcedo
1Pulmonary Dept, Clinica Universidad de Navarra, Pamplona, Spain
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Miguel Divo
2Pulmonary and Critical Care Division, Brigham and Women’s Hospital, Boston, MA, USA
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Ciro Casanova
3Pulmonary Dept, Hospital Universitario La Candelaria, Tenerife, Spain
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Victor Pinto-Plata
2Pulmonary and Critical Care Division, Brigham and Women’s Hospital, Boston, MA, USA
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Juan P. de-Torres
1Pulmonary Dept, Clinica Universidad de Navarra, Pamplona, Spain
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Claudia Cote
4Bay Pines VA Health Care System, St Petersburg, FL, USA
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Carlos Cabrera
5Pulmonary Dept, Hospital Universitario Dr Negrín, Las Palmas de Gran Canaria, Spain
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Jorge Zagaceta
1Pulmonary Dept, Clinica Universidad de Navarra, Pamplona, Spain
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Roberto Rodriguez-Roisin
6Pulmonary Dept, Hospital Clinic, Barcelona, Spain
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Javier J. Zulueta
1Pulmonary Dept, Clinica Universidad de Navarra, Pamplona, Spain
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Jose Maria Marin
7Pulmonary Dept, Hospital Miguel Servet, Zaragoza, Spain
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Bartolome Celli
2Pulmonary and Critical Care Division, Brigham and Women’s Hospital, Boston, MA, USA
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Abstract

Chronic obstructive pulmonary disease (COPD), although frequent in older individuals, can also occur at younger age; this latter population has not been well described.

We reviewed the functional progression of 1708 patients with COPD attending pulmonary clinics. Those with three or more annual spirometries were divided into those who, at enrolment, were ≤55 (n = 103) or ≥65 (n = 463) years of age (younger and older COPD, respectively). Baseline and annual changes in lung function (forced expiratory volume in 1 s (FEV1)) and BODE (body mass index, airflow obstruction, dyspnoea, exercise capacity) score were recorded and compared between both groups.

Severity distribution by Global Initiative for Chronic Obstructive Lung Disease and BODE scores were similar in both groups, except for mild obstruction, which was higher in the younger group. Mean FEV1 decline was 38.8 and 40.6 mL·year−1, while BODE scores increased 0.19 and 0.23 units per year, for younger and older COPD, respectively. Both groups had similar proportion of FEV1 rapid decliners (42% and 46%, respectively).

The severity distribution and progression of disease in younger patients with COPD is similar to that of patients of older age. This observation suggests that younger individuals presenting with COPD develop the disease from an already compromised pulmonary and systemic status, complementing the model of steeper decline of lung function proposed by Fletcher and Peto.

Abstract

Baseline distribution of COPD severity and disease progression is similar in younger and older patients http://ow.ly/uMKQ5

  • Received November 29, 2013.
  • Accepted March 15, 2014.
  • © ERS
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Disease progression in young patients with COPD: rethinking the Fletcher and Peto model
Pablo Sanchez-Salcedo, Miguel Divo, Ciro Casanova, Victor Pinto-Plata, Juan P. de-Torres, Claudia Cote, Carlos Cabrera, Jorge Zagaceta, Roberto Rodriguez-Roisin, Javier J. Zulueta, Jose Maria Marin, Bartolome Celli
European Respiratory Journal Jan 2014, erj02086-2013; DOI: 10.1183/09031936.00208613

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Disease progression in young patients with COPD: rethinking the Fletcher and Peto model
Pablo Sanchez-Salcedo, Miguel Divo, Ciro Casanova, Victor Pinto-Plata, Juan P. de-Torres, Claudia Cote, Carlos Cabrera, Jorge Zagaceta, Roberto Rodriguez-Roisin, Javier J. Zulueta, Jose Maria Marin, Bartolome Celli
European Respiratory Journal Jan 2014, erj02086-2013; DOI: 10.1183/09031936.00208613
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