Susceptible Young Adults and Development of Chronic Obstructive Pulmonary Disease Later in Life

Abstract Rationale Chronic obstructive pulmonary disease (COPD) has its origin in early life, and the Global Initiative for Chronic Obstructive Lung Disease (GOLD) proposes a predisease state termed “pre-COPD.” Objectives We tested the hypothesis that susceptible young adults identified with chronic bronchitis and subtle lung function impairment will develop COPD later in life. Methods We followed random individuals without COPD ages 20–50 years from two population-based cohorts from different smoking eras—the Copenhagen General Population Study from 2003 (N = 5,497) and the Copenhagen City Heart Study from 1976–1978 (N = 2,609)—for 10 and 25 years, for the development of COPD (FEV1/FVC <0.70) and COPD GOLD Stages 2–4 (additionally, FEV1 <80% predicted). Measurements and Main Results After 10 years, 28% developed COPD and 13% developed COPD GOLD Stages 2–4 in individuals susceptible to COPD, compared with 8% and 1% in those without any susceptibility to COPD. Correspondingly, after 25 years, 22% versus 13% developed COPD and 20% versus 8% developed COPD GOLD Stages 2–4. More than half of incident COPD cases developed from a susceptible state. Compared with those without susceptibility to COPD, multivariable-adjusted odds ratios in those susceptible to COPD were 3.42 (95% confidence interval: 2.78–4.21) for COPD and 10.1 (6.77–15.2) for COPD GOLD Stages 2–4 after 10 years and were 1.54 (1.23–1.93) and 2.12 (1.64–2.73) after 25 years. The ability of a COPD risk score—consisting of the state of susceptibility to COPD with smoking and asthma as risk factors—to predict COPD later in life was high. Conclusions Our study suggests the existence of a predisease state of COPD, which can be used for early identification of susceptible individuals at risk for COPD later in life.