Identification and Treatment of Patients with Early COPD

Abstract

This review addresses the need for greater awareness, timely and accurate diagnoses, as well as effective management of mild-to-moderate COPD in the primary care setting. A PubMed literature search was used to identify the epidemiology of undiagnosed COPD, and the potential benefits of early diagnosis that may result in improved outcomes for these patients. Lung function impairment and disabling symptoms have been detected in patients with mild undiagnosed COPD, with these patients showing significant limitations and physical impairment, which worsen over time. The 2014 GOLD guidelines emphasize the need for early detection, prevention, and approaches to management of COPD, including smoking cessation, early pharmacotherapy, and pulmonary rehabilitation, and recommend using a fixed forced expiratory volume in 1 second/forced vital capacity (FEV1/FVC) ratio of <0.70 in addition to symptoms and exacerbation risk to confirm diagnosis. Screening may represent a feasible approach to identify patients with mild-to-moderate disease. Screening tools, i.e. questionnaires and targeted spirometry, can aid early detection of COPD in people identified as at risk. Pharmacologic and non-pharmacologic interventions have been shown to improve patient care and quality of life; however, to date, only smoking cessation has been shown conclusively to slow COPD disease progression. Primary care professionals are in an excellent position to identify and diagnose COPD, and implement recommended treatment programmes, before it becomes advanced.