Updates in Chronic Obstructive Pulmonary Disease

By anand S. iyer, md, mSPh1,2,3 and r. Chad Wade, md1

Chronic obstructive pulmonary disease (COPD) is a serious respiratory illness that impacts over 15 million Americans and an estimated 380,000 Alabamians. Navigating the world of COPD treatments can be complicated, and clinicians may feel that treatment options are limited for people as the disease progresses. However, there is a lot we can still offer and much to come on the horizon.

A diagnosis of COPD requires three elements: 1) exposure, 2) symptoms, and 3) spirometry. Smoking remains an important cause of COPD and accelerates loss of lung function over time. However, smoking is just one of the many causes of COPD. An estimated 50 percent of COPD results from smaller lungs. The 2023 Global Initiative for Chronic Obstructive Lung Disease (GOLD) highlighted this through a new classification system for COPD that includes different exposure domains such as the environment (air pollution), genetic causes (alpha-1 antitrypsin deficiency), and early developmental abnormalities. Clinicians should think broad about potential exposures that can lead to COPD. When it comes to symptoms, hallmark

COPD symptoms include progressively debilitating breathlessness and chronic cough, but clinicians should consider other conditions such as interstitial lung disease or bronchiectasis, which cause similar symptoms as COPD. Measuring symptoms using the Medical Research Council Dyspnea scale (mMRC) and COPD Assessment Test (CAT) surveys is important to help quantify and track symptoms and should be implemented at all clinic visits. It is also important to document exacerbations, which increase the risk of death, cause significant burden for patients and their families, and are important factors in COPD staging. Finally, a diagnosis of COPD requires post-bronchodilator spirometry with airflow obstruction (defined by FEV1/FVC <0.70). Spirometry helps quantify the severity of COPD and helps clinicians decide on treatment. Furthermore, inhalers are unlikely to benefit people who do not have a clear COPD diagnosis, so spirometry is key to establishing a firm diagnosis. The debate over fixed airflow obstruction versus lower limit of normal criteria for diagnosing COPD is important but is a topic for another time.

– GOLD 2023

GOLD 2023 guidelines focus on treating the whole patient and taking into account comorbidities, which can