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KMID : 1141720220100020049
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폐쇄성폐질환
2022 Volume.10 No. 2 p.49 ~ p.53
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Redefining diagnosis and risk stratification of COPD
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Jung Ji-Ye
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Abstract
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COPD is a common, preventable, and treatable disease that is characterized by persistent respiratory symptoms, airflow limitation, airway and/or alveolar abnormalities, and caused by significant exposure to noxious particles or gases. The diagnosis of COPD requires the airflow limitation based on post-bronchodilator FEV1/FVC < 0.7. Although lung function is one of the most powerful predictors of clinically relevant outcomes, including symptoms, exacerbations, and mortality, it may not fully indicate the extent of disease severity and progression. Moreover, significant pathological and symptomatic change may have already developed before abnormal change of lung function. Although these individuals may eventually develop airflow obstruction consistent with a diagnosis of COPD, early intervention may modify the course of disease. In 2001, the Global Initiative for Chronic Obstructive Lung Disease (GOLD) proposed an “at-risk” stage of GOLD stage 0 who present respiratory symptoms without airflow limitation. However, it was later deleted because not all this group progressed to COPD. Therefore, we need to redefine the diagnosis and risk stratification of COPD to diagnose the possibility of COPD earlier and increase the possibility of treating earlier. Then, it may reverse damage before it is irreversible and impact the ultimate course of the disease. Risk stratification may include four different characteristics of COPD including clinical symptoms, pathological change based on chest CT, lung function and causative noxious environment exposure. Putting those factors all together may develop more categorized risk stratification of pre-COPD group who are at risk of developing COPD without currently air flow limitation.
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KEYWORD
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chronic obstructive pulmonary disease, definition, diagnosis, risk, stratification
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