A new study from an Italian research team was published this week in the journal Multidisciplinary Respiratory Medicine. The study, entitled “Health and social impacts of COPD and the problem of under-diagnosis,” sought to determine the prevalence, causes and potential strategies to overcome obstacles related to diagnosis underestimation and intervention of Chronic Obstruction Pulmonary Disease (COPD) in Italy.
The prevalence of COPD is estimated to be nearly 3% of the general population overall, however, the disease has been found to increase with age and in males, affecting 20% of males over 60 years old. In the U.S., COPD is estimated to be third leading cause of death, and has a high economic and social impact. Evidence from previous research showed that in Italy the rate of CPOD under-diagnosis ranges between 25-50% and that the condition is only detected when it is in an advanced stage.
In their study, Stefano Carlone and colleagues indicate that a missed diagnosis affects the start of intervention — which consequently is associated with poorer clinical outcomes — and suggest that early detection in the form of primary, secondary and tertiary prevention actions should be utilized by health care workers. These preventive actions for dealing with under-diagnosis include screening programs for smokers, the use of assessment instruments to evaluate the severity of COPD symptoms, spirometry for at-risk subjects (those aged above 40 years with known risk factors), and of course the need of an early diagnosis.
In clinical practice, a COPD assessment is usually made with the evaluation of the airway obstruction with FEV1. However, since COPD is known to be a multifactorial condition, it is necessary to combine its pulmonary and extrapulmonary components. In this regard, the authors suggest that FEV1 cannot be used as a single method for diagnosis, and that clinicians should consider evaluating COPD associated clinical features. Furthermore, in terms of effective therapy, Stefano Carlone and colleagues note that there is a need to identify which are the fundamental COPD components (including key phenotypes) so clinicians can achieve consensual intervention strategies.
The team of researchers concluded that early detection and early intervention are vital to improving clinical outcomes, which in the case of COPD are influenced by factors including prevention of lung function impairment, reduction of the risk of exacerbations, easing patients’ symptoms and improving their quality of life, and decreasing the costs of hospitalizations.