New developments in the assessment of COPD: early diagnosis is key

Nicholas G Csikesz, Eric J Gartman, Nicholas G Csikesz, Eric J Gartman

Abstract

Chronic obstructive pulmonary disease (COPD) is the most common chronic lung disease in the world, and its associated health burdens and costs are mounting. Until recently, it was generally accepted that targeting the diagnosis of COPD early in its course was a relatively fruitless effort, since treatments other than already ubiquitous smoking-cessation efforts were unlikely to alter its course. However, there is strong evidence to suggest that the majority of patients with objective COPD are not aware of their condition, and this leads to a significant delay in diagnosis, more aggressive smoking-cessation intervention, and potential treatment. Novel methods of diagnostic testing, community health programs, and primary-care provider recommendations hold promise to expand the recognition of COPD in its incipient stages - where recent evidence suggests a rapid decline in lung function occurs and may be prevented if acted upon. This review explores the evidence to support the efforts to justify programs aimed at early diagnosis, alternative diagnostic strategies that may augment traditional spirometry, therapeutic modalities that could potentially be used in the future to alter early lung-function decline, and emphasizes the necessary cooperative role that physicians, patients, communities, and governments need to play to realize the significant health impact that stands to be gained.

Keywords: early diagnosis; lung function; smoking cessation; spirometry.

Figures

Figure 1
Figure 1
Conventionally accepted time course of the natural progression of lung function as a result of exposure to smoking. Note: Reproduced from The natural history of chronic airflow obstruction. Fletcher C, Peto R. Br Med J. 1(6077):1645–1648. Copyright © 1977 with permission from BMJ Publishing Group Ltd. Abbreviation: FEV1, forced expiratory volume in 1 second.
Figure 2
Figure 2
Recent evaluation of rate of decline in lung function in patients with chronic obstructive pulmonary disease demonstrating that the largest rate of decline in lung function may occur in moderate disease. Notes: Copyright © 2012. Dove Medical Press. Reproduced from Lung function decline in COPD. Tantucci C, Modina D. Volume 7:95–99. Abbreviation: FEV1, forced expiratory volume in 1 second.

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