Published online Nov 28, 2013. doi: 10.5320/wjr.v3.i3.57
Revised: July 24, 2013
Accepted: August 16, 2013
Published online: November 28, 2013
The significant healthcare burden associated with chronic obstructive pulmonary disease (COPD) is driving us to improve our understanding of the natural history of this disease. Historically, the focus has been largely centred on diagnosing and treating individuals with moderate and severe disease. However, it is now recognised that the speed of decline in lung function as measured by forced expiratory volume in 1 s occurs faster in the earlier stages of the disease process. As a result, a clearer understanding of the potential benefits of treatment in early COPD is needed. It is recognised that many patients with COPD remain undiagnosed in the community which has prompted global case-finding initiatives. In this review we discuss the difficulties in diagnosing COPD in its early stages, examine the role of case-finding and look at the evidence for early intervention with therapeutic agents. There is a growing interest in the phenotypic variation amongst patients with COPD and we explore the role of phenotyping in early COPD and its potential benefits in providing a more individualised approach to COPD management. The majority of patients with COPD are known to die from non-respiratory causes such as cardiovascular disease. The mechanistic link is thought to relate to systemic inflammation, causing us to question whether earlier interventions could have a beneficial impact on the burden of co-morbidities for patients with COPD.
Core tip: In this review article we outline the difficulties in diagnosing chronic obstructive pulmonary disease (COPD) in its early stages and examine the role of case-finding initiatives. In addition we explore the evidence for early intervention with therapeutic agents and consider the impact of phenotyping in early disease, highlighting the potential benefits to a more individualized approach to COPD management.