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Original Research: COPD |

Global Initiative for Chronic Obstructive Lung Disease Stage 0 Is Associated With Excess FEV1 Decline in a Representative Population Sample

Roshan Brito-Mutunayagam, MBBS; Sarah L. Appleton, BSc; David H. Wilson, PhD; Richard E. Ruffin, MBBS, MD; Robert J. Adams, MBBS, MD; on behalf of the North West Adelaide Cohort Health Study Team
Author and Funding Information

From the Department of Medicine (Dr Brito-Mutunayagam), Rockhampton Base Hospital, Rockhampton, QLD; and The Health Observatory (Ms Appleton and Drs Wilson, Ruffin, and Adams), Discipline of Medicine, University of Adelaide, The Queen Elizabeth Hospital Campus, Adelaide, SA, Australia.

Correspondence to: Sarah L. Appleton, BSc, Discipline of Medicine, University of Adelaide, The Queen Elizabeth Hospital Campus, Woodville Rd, Woodville, Adelaide, SA, Australia 5011; e-mail:sarah.appleton@adelaide.edu.au


Funding/Support: This study was funded by the University of Adelaide and the South Australian Department of Health.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


© 2010 American College of Chest Physicians


Chest. 2010;138(3):605-613. doi:10.1378/chest.09-2607
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Background:  The Global Initiative for Chronic Obstructive Lung Disease (GOLD) guideline removed stage 0 (chronic cough and sputum without airflow obstruction, GOLD-0) because of poor prognostic value. Preventative intervention may be relevant for those with chronic symptoms; therefore, we assessed the stability, morbidity, and FEV1 decline associated with GOLD stage 0 in a representative adult population cohort.

Methods:  Baseline (n = 4,060) and follow-up (n = 3,206, mean 3.5 years) clinic assessment of the North West Adelaide Health Study included postbronchodilator spirometry, anthropometry, and measures of doctor-diagnosed asthma, respiratory symptoms, smoking status, quality of life, and depression.

Results:  Baseline GOLD-0 prevalence was 17.0% (n = 584). At follow-up (n = 420), 39.8% remained stable, 1.4% progressed to GOLD stages 1 to 2, and 58.8% resolved to no symptoms. Persistent GOLD-0 at follow-up was associated with persistent smoking (men: odds ratio [OR] = 11.9, 95% CI, 6.4-22.1; women: OR = 4.0, 95% CI, 2.1-7.4), and depressive symptoms (men: OR = 3.8, 95% CI, 1.9-7.6; women: OR = 3.2, 95% CI, 1.7-5.9), with highest quartile of FEV1 decline (mL) per year (OR = 2.1, 95% CI, 1.2-3.7) and the metabolic syndrome (OR = 1.7, 95% CI, 1.01-3.0) in men, and with older age in women. These associations generally held in smokers and never-smokers. Resolving GOLD-0 was associated with smoking cessation (OR = 13.7; 95% CI, 4.6-40.1), FEV1 decline (mL) per year below the median (OR = 2.0; 95% CI, 1.1-3.5), normal BMI, and younger age groups. Sensitivity analyses based on the presence of sputum did not change the observed associations.

Conclusion:  Persistent GOLD-0 identified people with physical and psychologic morbidity in both smokers and nonsmokers. Identification of those with persistent respiratory symptoms is therefore important. Excess FEV1 decline in men suggests GOLD-0 may identify a group at risk to progress to COPD over time.

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