Identification & Diagnosis

The challenge that we have is to identify these patients at a younger age if possible. Now we have pharmacotherapy and interventions that are effective and can prevent the progression of the disease. The sooner treatment begins, the better the outcome.

One of the major problems that we have in identifying COPD in women is that we don’t suspect it. There was a recent study done in the United States and Canada, and later repeated in Spain, where they presented a hypothetical patient to a group made up of primary care providers and specialists. Half of the group was told the patient was male, the other half was told the patient was female. The symptoms were complaints of shortness of breath, productive cough mainly in the mornings, some yellow clear phlegm, a history of smoking. Most of the physicians diagnosed COPD for the male patient, but less than half diagnosed COPD for the female patient. Most suspected that the female patient had asthma. That is because for years the image we had of a patient with COPD is an elderly man who has smoked. He is coughing and has impairment caused by the disease. We have to change that mental image. We have to look now at the image of a patient with COPD as a young woman because the main group of people smoking today is younger women. The big tragedy of this is that over the last 50 years we have come to understand the effects of cigarette smoking and have implemented interventions to improve disease management and improve life expectancy, but the twenty-year-olds are doing the same thing that their grandparents did 60 years ago. We have to target this generation, especially young women, in our efforts to diagnose COPD sooner. We also have to institute measures for smoking cessation in this group as soon as possible.

COPD causes physical changes in the lungs. Emphysema leads to a loss of the alveolar septae and as a consequence there is permanent enlargement of airway spaces. On the left side of the table you can see the normal alveoli. The alveoli are composed of billions of small balloons that create a huge surface that allows an effective gas exchange of oxygen and and CO2. On the right side is the lung of a patient with emphysema. There are large gaps, large holes, because the lung parenchyma have been destroyed and are now occupied by air that doesn’t participate in the gas exchange. Very often in these patients the air is trapped and the patients suffer hyperinflation.

COPD lung pathology can be present in all airways. The response of the airway is going to be a mucosal gland hypertrophy, production of mucus that is not effectively being cleared by the airway. Eventually there will be scar fibrosis. As the disease progresses there are more fibrotic changes, but the early abnormalities and changes in the airway, and the inflammation can be present independent of severe disease. Early diagnosis is important in order to stop the progression of the disease and its damage to the lungs.

There are three factors that you have to take into consideration when diagnosing COPD. First, the patient’s symptoms. Patients may not be aware that having a cough and sputum production, and being short-winded is not normal. Some patients assume that because they have smoked in the past or they still smoke they are supposed to cough every day.

Second, you have to put into consideration exposure to risk factors the patient might have. Cigarette smoke by far is the most common, but in some situations you will have occupational exposures to fumes that can be toxic to the lungs.

Third, the patient's spirometry result. Spirometry is the most effective tool to use in a diagnosis of COPD. It is as essential as the sphygmomanometer is to a diagnosis of hypertension. When a patient has the symptoms and risk factors for COPD you must use your tools to make a diagnosis.