Evaluation of Individuals at Risk for COPD: Beyond the Scope of GOLD

Abstract

The Global initiative for chronic Obstructive Lung Disease (GOLD) Strategy is a valuable tool for clinicians in the diagnosis and management of patients with established chronic obstructive pulmonary disease (COPD). However, there are no recommendations for the evaluation of individuals, exposed to risk factors, who are most likely to develop COPD. Consequently, it is necessary to consider all of the factors that may play a role in the pathogenesis of COPD: genetic factors, gender, socioeconomic status, disadvantageous factors in childhood, lung diseases and exposure to risk factors such as smoking, biomass fuel smoke, occupational hazards and air pollution. Along with the clinical assessment, periodic spirometry should be performed to evaluate lung function and make possible early detection of individuals who will develop the disease through the rate of forced expiratory volume in 1 second (FEV 1) decline. The first spirometry, periodicity, and clinically significant decline in FEV 1 will encompass the cornerstones of clinical follow up. This approach allows the implementation of important interventions in order to help individuals to cease contact with risk factors and prevent progressive respiratory impairment with the consequent deterioration of quality of life and increased morbidity and mortality. Abstract Abbreviations: Global initiative for chronic Obstructive Lung Disease, GOLD; chronic obstructive pulmonary disease, COPD; forced expiratory volume in 1 second, FEV 1 ; forced vital capacity, FVC; leukotriene B 4 , LTB 4 ; interleukin, IL; glutathione-s-transferase, GST; transforming growth factor beta, TGFβ; tumor necrosis factor alpha, TNFα; superoxide dismutase-3, SOD3; COPD Genetic Epidemiologist, COPDGene; nicotinic acetylcholine receptors, CHRNA; neural cell adhesion molecule 1, NCAM1; testis expressed 41/poly (A) binding protein, cytoplasmic 1 pseudogene 2, TEX41/PABPC1P2; dynein axonemal heavy chain 8, DNAH8; nucleolar protein 4-like, NOL4L; lipid phosphate phosphatase-related protein type 5, LPPR5; nephronectin, NPNT; tet methylcytosine dioxygenase 2, TET2; Major histocompatibility complex, class II, DQ beta 1/ major histocompatibility complex, class II, DQ alpha 2, HLA-DQB1/HLA-DQA2; KAT8 regulatory NSL complex subunit 1, KANSL1; tRNA splicing endonuclease subunit 54, TSEN54; single nucleotide polymorphisms, SNPs; hedgehog interacting protein, HHIP; advanced glycoslation end product-specific receptor, AGER; T helper cell, Th; Vascular endothelial growth factor, VEGF; socioeconomic status, SES; childhood disadvantage factors, CDF; airway hyperresponsiveness, AHR; asthma-COPD overlap syndrome, ACOS; chronic mucus hypersecretion, CMH; Mucin 5AC, MUC5AC; Mucin 5B, MUC5B; cytotoxic T lymphocytes, CD8+; chemokine [C-X-C motif] ligand 8, CXCL8; high resolution computed tomography, HRCT; lower limit of normal, LLN; percentage change in FEV 1 , %-ΔFEV 1