COPD: New Horizons for Early Diagnosis and a Better Life

 The following information is based on the publication “Exploring Current Concepts and Challenges in the Identification and Management of Early-Stage COPD” (J. Clin. Med. 2023, 12, 5293). The article was authored by a multidisciplinary team of leading Spanish specialists: Esperanza Doña, Rocío Reinoso-Arija, Laura Carrasco-Hernandez, Adolfo Doménech, Antonio Dorado, and José Luis Lopez-Campos. These experts work in university hospitals and respiratory departments in Malaga and Seville, as well as in the CIBERES research center at the Instituto de Salud Carlos III in Madrid. Their analysis summarizes the latest scientific concepts, diagnostic approaches, and treatment options for early-stage Chronic Obstructive Pulmonary Disease (COPD). The questions and answers presented below are selected to help guide patients and their loved ones, as well as healthcare professionals, through the most current and practically relevant aspects of early diagnosis and management of COPD.

“Early diagnosis and intervention in COPD can significantly alter the course of the disease and improve quality of life. Every patient has their own unique story—and their own chance for a better future.”

Why is early detection and treatment of COPD important?

COPD remains one of the leading causes of illness and death worldwide. Seventy percent of patients are diagnosed at an advanced stage, and half die within 3.6 years of their first hospitalization. New research and clinical initiatives are focused on identifying and treating COPD earlier to improve outcomes and patients' quality of life. Despite these efforts, the definition of “early-stage” COPD remains under scientific debate, and there is no universally accepted definition yet. Below are five key expert opinions and scientific recommendations that can serve as guideposts for awareness, self-monitoring, and informed discussions with your doctor.

1. What does “mild COPD” mean, and why is it not always an early stage?

“It has been shown that not all patients with mild COPD progress to more severe airway obstruction. Therefore, there are patients with mild disease that do not progress to more advanced stages even if they continue to smoke. In addition, recent studies have shown that a proportion of COPD patients experience a normal decline in lung function from a low peak lung function in early adulthood, and that the degree of lung function development may be impaired from an early stage of life. Consequently, the idea of COPD as a disease that starts out mild and then proceeds to progressive functional decline may not be true in either of its two premises at the patient level. Therefore, having mild COPD is not a valid way of identifying individual patients who will have accelerated lung function decline in the future.”

Explanation: Mild COPD doesn’t always lead to severe disease. Some people with mild symptoms may not worsen significantly, while in others, the condition may begin in early life or result from inherited factors. A diagnosis is not a prognosis! Regular monitoring and a personalized approach are essential.

2. What risks does COPD pose for younger patients, and why is early detection critical?

“Notably, the available evidence shows that young patients are not asymptomatic; instead, they have a higher symptom burden, worse HRQoL, and considerably more exacerbations than older COPD subjects. Additionally, there is also evidence that COPD subjects under the age of 50 years old have a more accelerated FEV1 loss. Notably, some treatments, such as tiotropium, have been shown to improve HRQoL, decrease exacerbation rate and lead to a significant reduction in the decline in post-bronchodilator FEV1 in younger patients with COPD.”

Explanation: COPD in young people is often underestimated, but symptoms may be pronounced, with poorer quality of life and a faster decline in lung function. Early diagnosis and treatment can slow or even reverse this process.

3. What is the concept of “early COPD,” and why is it difficult to define?

“Early COPD seems to refer to the moment when this increased inflammation starts, if such a moment exists, which therefore corresponds to when the obstruction begins to appear, therefore making it a more biological concept… Unfortunately, it is not known when this onset of inflammation occurs, and it will probably present differently in different types of COPD patients.”

Explanation: Early COPD is associated with the onset of inflammation in the lungs. However, the exact timing and mechanism of this beginning remain unclear. Diagnosis requires a complex approach, often including risk factor monitoring, family history, and early clinical and imaging changes.

4. What is “pre-COPD” and what are the early warning signs?

“The definition of the term pre-COPD indicates that it refers to people with respiratory symptoms. Among these we must highlight those with chronic cough and expectoration, otherwise termed chronic non-obstructive bronchitis. These are relevant for being most commonly associated with a higher risk of COPD progression, as well as being related to worse HRQOL and episodes similar to exacerbations.”

Explanation: Pre-COPD refers to individuals with symptoms like chronic cough and phlegm production but no airflow obstruction detected by spirometry. These patients are at higher risk and need close monitoring. Prevention and observation are key at this stage.

5. What is PRISm and what does it mean for patients?

“This term refers to individuals with a healthy FEV1/FVC ratio (i.e., without airflow obstruction) but with impaired spirometry in the form of a decrease in either FEV1 or FVC. Interestingly, several factors make this form of functional pre-COPD worth considering beyond its mere prevalence. Subjects with PRISm seem to have specific characteristics associated with this form of lung function impairment, such as frequent cases of nutritional disturbances. There is also evidence that PRISm is associated with greater respiratory symptomatology, lower exercise tolerance and more admissions than people with normal spirometry. Consequently, it is not surprising that this form of pre-COPD may be related to mortality after adjusting for comorbidities and smoking.”

Explanation: PRISm is a specific spirometric finding: the FEV1/FVC ratio is normal, but either FEV1 or FVC is reduced. This condition is linked to worse outcomes, more symptoms, and a higher risk of hospitalization and mortality.

Questions and Answers

1. Is it possible to stop or slow the progression of COPD if it’s detected early?

Answer: Yes. According to the article, there is strong evidence that early intervention—both pharmacological and non-pharmacological—can change the natural course of the disease and slow its progression. Starting inhalation therapy early and quitting smoking can reduce the rate of lung function decline and improve outcomes, especially when the disease is still in a mild stage.

2. Are there specific symptoms I should watch for if I’m in a risk group but don’t have lung obstruction?

Answer: Yes. Even without confirmed obstruction (known as “pre-COPD”), it’s important to monitor for symptoms such as chronic cough, phlegm production, shortness of breath during exertion, and reduced physical endurance. People with these symptoms—especially those with a history of smoking or exposure to dust/pollution—should be closely followed, even if their spirometry is still normal, because they are at increased risk of developing COPD.

3. What can I do myself to reduce the risk or slow COPD progression in its early stages?

Answer: The article emphasizes that quitting smoking is the most important step any patient can take, at any stage—but especially in the early phases. Regular physical activity, avoiding polluted environments, and preventing respiratory infections are also crucial. Even in “mild” COPD, these actions can significantly slow the decline in lung function and improve quality of life.

4. Can I have COPD if I’m young (under 50), and what are the differences?

Answer: Yes. According to the article, COPD can occur in people under 50, especially smokers. This group is often underestimated and underdiagnosed, even though young patients may have more severe symptoms and faster loss of lung function. They also experience more frequent flare-ups and worse quality of life, making early recognition and intervention critical.

5. Are there more accurate ways to detect early COPD than standard spirometry?

Answer: Yes. While spirometry is the standard method, it can miss some early or atypical cases. More advanced tests like lung diffusion capacity (DLCO), computed tomography (CT) to detect structural changes, and modern techniques for assessing small airway function (such as impulse oscillometry) can help identify the disease earlier—sometimes even before classical symptoms or obstruction appear.

Source: Doña, E., Reinoso-Arija, R., Carrasco-Hernandez, L., Doménech, A., Dorado, A., Lopez-Campos, J.L. Exploring Current Concepts and Challenges in the Identification and Management of Early-Stage COPD. J. Clin. Med. 2023, 12, 5293. https://doi.org/10.3390/jcm12165293