Early Detection and Impaired Quality of Life in COPD GOLD Stage 0: A Pilot Study

Author： Maleki-Yazdi M. Reza Lewczuk Christine Haddon Jennifer Choudry Nozhat Ryan Nancy

ISSN： 1541-2555

Source： COPD: Journal of Chronic Obstructive Pulmonary Disease, Vol.4, Iss.4, 2007-12, pp. : 313-320

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Abstract

This pilot study aimed to identify early stages of chronic obstructive pulmonary disease (COPD) in an urban population of smokers and ex-smokers using the Global Initiative for Chronic Obstructive Lung Disease (GOLD 2001, 2003) classification guidelines and to assess the impact of early disease on quality of life. Smokers and ex-smokers of ≥ 10 pack years and age ≥ 50 years were recruited. After an initial telephone interview, eligible subjects completed a clinical assessment, spirometry tests, and the St. George's Respiratory Questionnaire (SGRQ). A total of 244 subjects completed the study; 91 subjects (37%) were normal, 153 subjects (63%) met the criteria for GOLD stages 0 to III: 65 stage 0 (27%), 43 stage I (18%), 38 stage II (16%), 7 stage III (3%) and 0 in stage IV. The stage 0 patients were younger than any other COPD groups (p < 0.0005), including normal subjects (55.5 ± 5.4 years vs. 59.6 ± 7.2 years; p = 0.0005). The frequency of current smoking in stage 0 patients was greater than those in the normal category (80% vs. 33%; p < 0.0001). There were significant impairments in quality of life measures between normal subjects and all GOLD stages (SGRQ total scores; p < 0.0001) except for stage I (SGRQ total scores; p = 0.1409). Subjects with COPD at GOLD stage 0 were markedly under-diagnosed. These subjects had a significant impairment in their health-related quality of life measures, were younger than other categories, and were mostly current smokers. Thus, detection of COPD at GOLD stage 0 may provide a unique opportunity for early intervention and smoking cessation and the removal of GOLD stage 0 from the 2006 update should be re-assessed.