At the Root: Defining and Halting Progression of Early Chronic Obstructive Pulmonary Disease

• DOI: 10.1164/rccm.201710-2028pp
• Publication Date: 2018-02-06T19:27:16Z
• Authors: Fernando J. Martinez; MeiLan K. Han; James P. Allinson; R. Graham Barr; Richard C. Boucher; Peter M. A. Calve...; Bartolome R. Celli; Stephanie A. Chri...; Ronald G. Crystal; Malin Fagerås; Christine M. Freeman; Lars Groenke; Eric A. Hoffman; Mehmet Kesimer; Kostantinos Kostikas; Robert Paine; Shahin Rafii; Stephen I. Rennard; Leopoldo N. Segal; Renat Shaykhiev; Christopher Steve...; Ruth Tal-Singer; Jørgen Vestbo; Prescott G. Woodruff; Jeffrey L. Curtis; Jadwiga A. Wedzicha
• Keywords: Root (linguistics)

Chronic obstructive pulmonary disease is a heterogeneous disorder with varying presentation and progression, but limited disease-modifying therapies.It increasingly evident that lung function trajectories in COPD differ significantly differences are detectable young adulthood.It important to distinguish "early disease" meaning the first signs of developing individual from "late mild may be severity an older have been present for decades.We propose operational definition early as occurring person younger than 50; either: (1) FEV1/FVC less lower limit normal; or (2) respiratory symptoms CT abnormalities (airway abnormality and/or emphysema), (3) evidence accelerated FEV1 decline; (4) any combination categories through (3).The biological underpinnings quite complex.Recent implies cigarette smoke-exposure induces sequential, stereotypical changes distal airways, absence inflammatory cell infiltration.Epithelial reprogramming associated mucus readily cleared.Focal airway injury has also polymeric immunoglobulin receptor downregulation.Resulting microbial community structures might prove mechanistically important.Global gene analysis suggests tissue degradation around small airways predominates over repair.Emphysema develop due loss endothelial cell-derived factors.To reduce COPD's long-term societal impact, goal interventions must change, sole focus on reducing exacerbations advanced disease, halting pathological progression disease.This review attempts stimulate studies focused people understand causes, clinical experession potential therapeutic targets COPD.