Experts Say Early COPD Detection Is Key to Better Outcomes

Earlier diagnosis and intervention in chronic obstructive pulmonary disease (COPD) could be the most important change for improving outcomes over the next 5 years, according to Àlvar Agustí, MD, PhD, professor of medicine at the University of Barcelona; Jadwiga A. Wedzicha, MD, professor of respiratory medicine at the National Heart and Lung Institute, Imperial College London; Francesca Polverino, MD, PhD, Lester and Sue Smith Professor of Medicine at Baylor College of Medicine; Emily S. Wan, MD, assistant professor of medicine at Harvard Medical School; and David Halpin, MA, DPhil, MBBS, honorary professor of respiratory medicine at the University of Exeter.

In interviews with The American Journal of Managed Care^®, Agustí, Wedzicha, Polverino, Wan, and Halpin discussed the biggest change that would improve outcomes for people with COPD, from earlier diagnosis to fewer exacerbations.

Why Early Diagnosis Is the Priority

Agustí said the clearest need is early diagnosis and early intervention. “We arrive late to COPD,” Agustí said. Patients are diagnosed too late, according to Agustí, and available treatments would be much more effective if applied earlier in people who are not necessarily ill. Addressing underdiagnosis, misdiagnosis, and late diagnosis is essential, Agustí said.

Wan described a real movement to identify COPD at earlier stages, using the same concept applied to rheumatoid arthritis: treat early to change the course of the disease and keep it from getting worse.

Halpin said many people in the community have COPD symptoms but have not been diagnosed. Finding them and starting appropriate management could make a real difference, Halpin said, and it does not require a great technological advance or new therapies.

“It just requires a consistent approach to thinking about whether people have COPD or not,” Halpin said.

How Fewer Exacerbations Could Change the Disease

Wedzicha said the best outcomes will come from reducing exacerbations even further, which would lower hospitalizations and health care costs and also slow disease progression. That is the next target, Wedzicha said, and it will mean much earlier interventions. Studies of biologics have shown that younger patients with milder disease benefit more, Wedzicha noted, and that group will need to be targeted in the future.

Polverino pointed to 2 changes. The first is about to arrive: giving biologics regardless of blood eosinophil count, as new drugs targeting interleukin 33 launch. The second is prevention.

“We cannot wait until the patients start exacerbating before treating,” Polverino said.

Polverino said the field needs clinical trials in early disease, such as GOLD 0 and GOLD 1. They will be challenging, but if successful, they could change the course of the disease.