COPD Diagnosis: Time for Disruption

Abstract

Articulating a satisfactory definition of a disease is surprisingly difficult. Despite the alarming individual, societal and economic burden of chronic obstructive pulmonary disease (COPD), diagnosis is still largely based on a physiologically dominated disease conception, with spirometrically determined airflow limitation as a cardinal feature of the disease. The diagnostic inaccuracy and insensitivity of this physiological disease definition is reviewed considering scientific developments of imaging of the respiratory system in particular. Disease must be approached as a fluid concept in response to new scientific and medical discoveries, but labelling as well as mislabelling someone as diseased, will have enormous individual, social and financial implications. Nosology of COPD urgently needs to dynamically integrate more sensitive diagnostic procedures to detect the breadth of abnormalities early in the disease process. Integration of broader information for the identification of abnormalities in the respiratory system is a cornerstone for research models of underlying pathomechanisms to create a breakthrough in research.

Diagnostic Potential of Oscillometry: A Population-based Approach

“…In our dataset, the addition of oscillometry to spirometry measurements allowed an additional 17% of the population with symptoms/diagnoses to be identified with abnormal lung mechanics. These results support the concept of integrating oscillometry into the clinical diagnostic routine to objectively identify early abnormalities ( 41 ). This is particularly relevant as spirometry, despite its widespread use as a single diagnostic test, may not capture certain aspects of respiratory abnormalities that specifically affect small airways ( 42 , 43 ).…”

Chronic Obstructive Pulmonary Disease Overdiagnosis and Overtreatment: A Meta-Analysis

“…The false positive prevalence may be attributed to the physician's incapacity of distinguishing COPD to other clinical conditions due to the similar symptomatology with other diseases [57,58] and the under-use of spirometry [28]. Patients with overlapping COPD symptoms, like cough, breathlessness and dyspnea, may be empirically labeled by the physician as "GOLD 0", leading to possible diagnostic confusion [59,60]. Conditions like asthma, obesity, cardiac pathologies, restrictive patterns, and aging may be the condition underneath the refereed symptoms [61,62].…”