COPD is a relatively new diagnosis, but is nonetheless a controversial one. There are defining characteristics of COPD (namely, irreversible lung damage, constriction of airways, unresponsiveness to steroids), but not a clear, distinct definition. Some view COPD as an “umbrella term” of respiratory diseases. In fact, in the process of researching this disease, I talked to a resident who mentioned something along the lines of “sometimes, we diagnose a patient with COPD when they have multiple respiratory complaints that are of a certain severity and have been correlated with COPD and we can’t find another, more fitting answer”. While this scenario may not sit well with the average individual, it does reflect a very real shortcoming of medicine when it comes to COPD. Besides performing lung biopsies or checking chest CT’s (and exposing those with risk factors for lung cancer to intense radiation that can cause cancer), there are few sure-fire ways to check a patient for signs of COPD. Today, checking a FEV1/FVC level and considering risk factors is the most agreed-upon method of diagnosing COPD, but there is certainly potential for improvement.
COPD, being a leading cause of death, cannot be taken lightly. There is a need for more stringent definitions & requirements for a COPD diagnosis to avoid misdiagnosis and mistreatment of patients. Because of the chronic nature of COPD, perhaps there should be more emphasis placed on primary-care physicians in terms of monitoring a patient’s history, risk factors, and complaints over time so as to better differentiate COPD from other respiratory diseases. This is to say that an individual presenting to the emergency department with unexplained shortness of breath and being diagnosed with COPD is not the most viable nor the safest practice.
The Molecular Basis
Currently, there are many well-supported correlations made that lead to an understanding of COPD on the tissue & cellular levels. For example, over-activity of the inflammatory response and reactive oxygen species are known to be involved, as well as enzymes such as alpha-1-antitrypsin. However, future work needs a focus on the molecular level for a better understanding of COPD so that, ultimately, better treatments and management options are available.
Treatment and Management
The symptoms of COPD are caused by irreversible lung tissue damage, which is, expectedly, difficult or impossible to truly treat. The better management of COPD patients, however, is an area that could be significantly improved within the near future. Again, it is important to have clearer and more precise criteria for identification and diagnosis of COPD so that management can start sooner. The effects of cigarette smoking, especially those related to COPD, need to be more effectively presented to people – everyone, at every age – and especially to those that begin to manifest symptoms of COPD. The cessation of smoking is futile in terms of recovering damaged lung tissue, but it is certainly a great step closer to a longer life when it comes to COPD management.
It should be noted that most deaths associated with COPD are due to COPD exacerbations, which are episodes of severe symptoms, which typically require hospitalization. Whereas COPD is not understood to a great extent currently, the causes of COPD exacerbations and the factors that determine their severity are understood to a lesser extent. This is especially concerning, given the fatality of these exacerbations. However, exacerbations are inherently more difficult to study, given their often random occurrences. This means that, in terms of exacerbations, there needs to be research on the causes of COPD exacerbations on a molecular level, so that possible treatments can be developed to lessen the severity of exacerbations in a hospital or at an at-home setting.