Long-term outcomes in mild/moderate chronic obstructive pulmonary disease in the European community respiratory health survey

Roberto De Marco*, Simone Accordini, Josep M. Antò, Thorarinn Gislason, Joachim Heinrich, Christer Janson, Deborah Jarvis, Nino Künzli, Bénédicte Leynaert, Alessandro Marcon, Jordi Sunyer, Cecilie Svanes, Matthias Wjst, Peter Burney

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

46 Citations (Scopus)


Rationale: Little is known about the long-term outcomes of individuals with mild/moderate chronic obstructive pulmonary disease (COPD) according to spirometric criteria. Objectives: To test whether nonsmokers and asymptomatic subjects with a spirometric diagnosis of COPDhave a steeper decrease in lung function and higher hospitalization rates than subjects without airway obstruction. Methods:A total of 5,205 subjects without asthma (20-44years ofage) from the general population,with FEV1≥ 50%predicted at baseline, were followed for 9years in the frame of an international cohort study. Percent decrease in FEV1 (ΔFEV1%) and the annual hospitalization rate for respiratory causes during the follow-up were assessed for each subject. Measurements and Main Results: At baseline, 324 (6.2%) subjects had the prebronchodilator FEV1/FVC ratio less than the lower limit of normal (LLN-COPD), and 105 (2.0%) subjects had the same ratio less than 0.70 (modified GOLD-COPD). At follow-up, smokers with LLNCOPD (n5 205) had a greater mean ΔFEV1%(1.7%; 95%confidence interval [CI], 0.8-2.7) and a higher hospitalization rate (rate ratio [RR], 2.52; 95%CI, 1.65-3.86) thannormal subjects. Similarly, symptomatic subjects with LLN-COPD (n 5 104) had ΔFEV1% (2.0%; 95% CI, 0.8-3.3) and the hospitalization rate (RR, 4.18; 95%CI, 2.43-7.21) higher than the reference group.By contrast, nonsmokers and asymptomatic subjects with LLN-COPD had outcomes that were similar or even better than normal subjects. Among subjects with LLN-COPD, the association of symptoms with ΔFEV1% varied according to smoking habits (P 5 0.007); it was particularly strong in symptomatic smokers and disappeared in symptomatic nonsmokers. Similar results were found with the modified GOLD classification. Conclusions: In relatively young populations, COPD is associated with poor long-term outcomes in smokers and in symptomatic subjects only.

Original languageEnglish
Pages (from-to)956-963
Number of pages8
JournalAmerican Journal of Respiratory and Critical Care Medicine
Issue number10
Publication statusPublished - 15 Nov 2009
Externally publishedYes


  • Cohort studies
  • COPD
  • Hospitalization
  • Smoking
  • Spirometry


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