Early diagnosis was one of the goals identified by the EFA 2013 report to achieve patient-centred minimum standards of care for COPD. Early diagnosis of symptomatic individuals is crucial to prevent irreversible airflow limitation and lung tissue damage, which can significantly impact the patient’s outcome. Despite implementing some best practices, there has been no significant improvement in early diagnosis in the 19 countries surveyed over the last 10 years. Misdiagnosis or diagnosis of COPD at advanced stages can effectively reduce life expectancy and its quality.
Delayed diagnosis places a significant burden on patients and society (Agarwal, 2023). Patients with severe COPD (GOLD grades 3 and 4) and those with a history of severe acute exacerbations have a considerable reduction in life expectancy [2]. Conversely, patients diagnosed with mild stage COPD (GOLD grade 1) may not experience such reduction compared to healthy people [2]. Therefore, early, and correct diagnosis of symptomatic individuals, especially smokers with ongoing cough, continues to be a major issue. Individuals at-risk, including current and ex-smokers and passive smokers over 35, should receive spirometry testing as part of their regular health check-ups.
In this context, EFA also identified the need to increase healthcare professionals’ (HCPs) training, particularly among primary care practitioners and GPs, to administer spirometry and interpret the results. In fact, COPD is often poorly recognised. EFA-commissioned research revealed that patients who initially received a wrong diagnosis (16% of the sample) had to wait on average five years to receive the right one. Delayed diagnosis led to an increase in disease severity and the risk of adverse outcomes. In fact, 75% of patients who received an initial misdiagnosis went on to develop moderate to severe COPD (EFA, 2019).
Early interventions, particularly smoking cessation (see “Reduce exposure to cigarette smoking and vaping”), are associated with a subsequent absence of chronic symptoms [3].
Notably, early diagnosis of COPD is critical not only for managing the condition, but also for lung cancer surveillance. COPD patients, especially those with severe disease, have a higher risk of developing lung cancer. Thus, regular follow-ups should be considered in patients with COPD [4].
Policies aimed at promoting early diagnosis of COPD should focus on four dimensions:
- Spirometry screening programmes targeted at the at-risk population, ideally by enrolling them in a lung health plan;
- Wide availability of spirometry in primary care services;
- Awareness campaigns targeted to the general population to promote symptom recognition;
- Research on the physio pathological mechanisms of COPD and on new biomarkers for very early diagnosis, particularly among nonsmoker patients.