Mild chronic obstructive pulmonary disease: why spirometry is not sufficient!. (3rd July 2017)

• Record Type: Journal Article
• Authors: Elbehairy, Amany F.; Parraga, Grace; Webb, Katherine A.; Neder, J Alberto; O'Donnell, Denis E.
• Is Part Of: Expert review of respiratory medicine. Volume 11:Number 7(2017)
• Page Start: 549
• Page End: 563
• Publication Date: 2017-07-03
• Subjects: Mild COPD -- spirometry -- imaging -- small airway remodeling -- vascular injury -- exercise -- dyspnea; Respiratory organs -- Diseases -- Periodicals; Respiratory organs -- Diseases -- Treatment -- Periodicals; 616.2005
• DOI: 10.1080/17476348.2017.1334553
• Languages: English
• ISSNs: 1747-6348

Abstract

ABSTRACT: Introduction : Chronic obstructive pulmonary disease (COPD) – an inflammatory disease of the airways, alveoli and lung microvasculature – is a leading cause of death worldwide. Smokers with milder airway obstruction constitute the majority of patients with this disease. Many studies have shown increased morbidity, activity-related dyspnea, exercise intolerance and mortality in such patients, compared with age-matched healthy populations. Clinical evaluation of symptomatic smokers with ostensibly mild airway obstruction poses a challenge in clinical practice as spirometry can obscure extensive heterogeneous pathophysiological impairment. Areas covered : A detailed review of the evidence for complex biological, physiological and radiological abnormalities in smokers who barely fit arbitrary spirometric criteria for COPD diagnosis. A brief discussion of the debate about current diagnostic spirometric criteria for COPD that can lead to diagnostic confusion and, in-some-instances, to inappropriate management. Finally, we provide a review of the clinical implications of these structural and functional abnormalities and try to build a solid rationale for earlier detection and effective, timely management. Expert commentary : The prevalence of mild COPD among smokers is high, yet under-diagnosis remains a major problem and there is lack of evidence-based management recommendations for this sub-population. Further tests beyond spirometry are useful in uncovering patho-physiological derangements that are clinically relevant.