Early COPD: current evidence for diagnosis and management

Abstract

Chronic obstructive pulmonary disease (COPD) affects one-tenth of the world’s population and has been identified as a major global unmet health need by the World Health Organisation, which predicts that within 10 years, COPD will become the third leading cause of death. Despite active research, there have been no recent major strides in terms of disease modifying treatment for COPD; smoking cessation remains the only intervention known to alter disease progression and improve mortality. As established COPD is a key driver of disease burden, earlier diagnosis coupled with disease-modifying intervention carries promise as a route to address this global health priority. The concept of early COPD is emerging as an area of focus for research and consideration of new treatment modalities, as it has been hypothesised that intervention at this stage may potentially halt or reverse the disease process. However, at present, a globally accepted criteria for defining early COPD does not exist. Several studies propose small airways disease as the earliest stage in the development of COPD, and this has been demonstrated to be a precursor to development of emphysema and to correlate with subsequent development of airflow obstruction. However, treatment strategies for early disease, which pre-date the development of airflow obstruction, remain uncertain. This review addresses the rationale and current evidence base for the diagnosis and treatment of early COPD and highlights the challenges of implementing trials and clinical pathways to address COPD earlier in the life course, particularly in the absence of a universally accepted definition of COPD. The reviews of this paper are available via the supplemental material section.

Quality Standard Position Statements for Health System Policy Changes in Diagnosis and Management of COPD: A Global Perspective

“…Consequently, 65–80% of COPD cases remain undiagnosed [ 46 ]. Although there is limited evidence of the disease-modifying effects of treatment in the early stages of disease [ 47 , 48 ], smoking cessation can retard the progression of mild COPD [ 48 ]. Additionally, early and accurate diagnosis, as well as appropriate pharmacological and/or nonpharmacological treatment, may attenuate deterioration [ 26 ].…”

Chronic Obstructive Pulmonary Disease: Epidemiology, Biomarkers, and Paving the Way to Lung Cancer

“…Remodeling small airways, wall thickening of the small bronchi, destruction of lung parenchyma, loss of alveolar space, and consequent decreased respiratory area are the main pathological changes in COPD. Therefore, imaging techniques (X-ray or high-resolution computer tomography) are used for diagnosis and control of pulmonary emphysema and bronchial wall thickening [65]. However, the basic diagnostic method has remained the spirometry lung function test in COPD.…”

Review on Chronic Obstructive Pulmonary Disease Prediction System using Wheeze and Crackle.

“…This is a disease that affects one-tenth of the world's population. Within ten years COPD is expected to become the 3rd leading cause of death" [9]. The previous diagnosis has been identified as a major solution to disease control.…”