Chronic obstructive pulmonary disease (COPD) is the name for a group of lung conditions that cause breathing difficulties. These conditions include emphysema and chronic bronchitis. It's a common condition that affects middle-aged or older adults who smoke at large. The breathing issues it causes generally worsen over time and can limit normal, daily life activities.
The symptoms of COPD include getting increasingly breathless, having a persistent and chesty cough with phlegm, frequent chest infections, and persistent wheezing. COPD also may cause weight loss, tiredness, edema, and chest pains and coughing blood less commonly; but these additional symptoms generally only happen when the disease becomes advanced.
Early detection of COPD: Diagnosis processes
An issue with COPD is the fact that it remains very underdiagnosed in primary care because the presence of symptoms is not a reliable indicator for diagnosis. This causes the diagnosis to be frequently delayed until more severe obstructions in the airways become present and pressing.
Spirometry is very under-utilized in the diagnosis of COPD, even though it is accepted as the diagnostic test to assess airflow obstructions and determine the severity of the disease.
Early diagnosis creates more opportunities to prevent the worsening of the disease (by the patient quitting smoking, for example) and also can ensure that comorbidities are prevented.
Spirometry and COPD
Spirometry can detect COPD in the early stages, but the benefits are not limited only to detection. It can help track the progression of the disease and help narrow down the treatments that are most effective.
Once the stage of COPD, meaning the classification of airflow limitation severity caused by the disease is determined, the healthcare team has the ability to set a treatment course accordingly.
According to Global Initiative for Chronic Obstructive Lung Disease, in patients with FEV1/FVC ratios less than 0.7, staging is as follows:
- GOLD 1: Mild COPD, FEV1 percentage is less than 80% of the predicted percentage.
- GOLD 2: Moderate COPD, FEV1 percentage is between 50% and 80% of the predicted percentage.
- GOLD 3: Severe COPD, FEV1 percentage is between 30% and 50% of the predicted percentage.
- GOLD 4: Very severe COPD, FEV1 percentage is less than 30% of the predicted percentage.
- “COPD: Symptoms and Causes”, Mayo Clinic, 2020.
- “Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease”, Global Initiative for Chronic Obstructive Lung, Gold Report, 2021.
- "Diagnosis and early detection of COPD using spirometry", Journal of Thoracic Disease, 2014.
- "Spirometry in Chronic Obstructive Pulmonary Disease. From Rule of Thumb to Science", American Journal of Respiratory and Critical Care Medicine, 2016.