More effective diagnosis and disease prevention

Disease prevention

Smoking cessation is the primary measure for disease prevention.

The Global Initiative for Chronic Obstructive Lung Disease (GOLD) definition of COPD emphasises the importance of persisting airflow obstruction associated with inflammation and occurring as a consequence of inhaled noxious substances.¹ Primary prevention of COPD has therefore focused on tobacco control and there is some evidence that this has been important in reducing the burden of COPD in the EU and USA. The main burden of tobacco use is now in the rapidly developing economies of China, India and South East Asia who need to be encouraged in smoking cessation interventions to prevent the development of COPD.

More effective diagnosis

Better markers of disease activity are needed to establish a more effective diagnosis.

Diagnosis and grading of COPD severity is largely based on the measurement of FEV₁.¹ Although FEV₁ is reproducible and consistent, it does have limitations as it measures only one aspect of the disease and is not predictive of disease progression, especially in early disease.^{2, 3}  Patients with similar FEV₁ may have very different underlying pathology; e.g. predominantly air space disease (i.e. emphysema) or disease of the airways, as manifested by increased thickness of the airway wall.⁴ In the future, other clinically relevant endpoints are needed to establish a more accurate diagnosis. With better intermediate markers of disease activity and a clear understanding of the way in which symptoms relate to structural change, clinicians would be in a stronger position to modify the natural history of COPD and reduce its clinical impact.

References

1. Global Initiative for chronic obstructive lung disease: Global strategy for the diagnosis, management, and prevention of COPD. 2010. www.goldcopd.org.
2. Franciosi LG, Page CP, Celli BR, et al. Markers of disease severity in chronic obstructive pulmonary disease. Pulm Pharmacol Ther 2006;19:189-199.
3. Gross NJ. Outcome measures for COPD treatments: A critical evaluation. COPD 2004;1:41-57.
4. Gelb AF, Hogg JC, Müller NL, et al. Contribution of emphysema and small airways in COPD. Chest 1996;109:353-359.