5.8.5. Control tools and policies
COPD is a progressive disease, which could be easily and
early diagnosed via spirometry. Most relevant risk factors have been identified
and their removal could substantially reduce the prevalence of COPD and its
progression to more severe stages. Main actions should focus on the prevention
of smoking uptake, and on improved workplace air quality. If preventive actions
are not promoted, an increase is expected in the proportion of patients at end
Differential diagnosis of COPD includes asthma,
bronchiectasis, tuberculosis, congestive heart failure (CHF), obliterative
bronchiolitis and diffuse panbronchiolitis (Siafakas et al, 2006). For this
reason, chest examination, lung function tests, imaging techniques and clinical
history should be used to direct the decision process.
Different studies have focused on the screening of the
population at risk, with the aim of overcoming COPD under-diagnosis and
strengthening interventions to stop smoking. Cessation of smoking is associated
with a return of the rate of decline of pulmonary function to that of never-smokers.
The highest benefits are observed in young quitters (Anthonisen, 2002). During
the first year after smoking cessation, patients showed an increase of 47 ml
FEV1, compared with a decrease of 49 ml FEV1 among continuing smokers (Scanlon
et al, 2000).
An interesting study performed in Poland presented a promising approach for early detection of COPD in high risk population
by means of spirometric screening (Gorecka et al, 2003). The results showed
that AO spirometric signs were present in 24.3% of 40+ year old smokers with a
smoking history of 10+ pack-years (n=11,027). After a minimal antismoking
intervention, the validated smoking cessation rate in patients with AO was
16.3%, whereas it was 12.0% in those with normal spirometric parameters (p<0.001).
In the second part, the study involved a total of 110,355 subjects (aged
53.5±11.5 yrs; 58.2% males) among which 64% were current smokers, 25.1% former
smokers and 10.9% lifelong non-smokers. In 20.3% AL sign were present (mild in
7.6%, moderate in 6.7% and severe in 5.9%). AL was found in 23% of smokers aged
40 with a history of
Therefore, it was shown that a large-scale voluntary spirometry screening of
the population at high risk of COPD, i.e. smokers, can reveal the early
presence of AL in a large number of patients at a reasonable cost.
Different COPD guidelines have been issued: in 2004 by the
American Thoracic Society (ATS) and the European Respiratory Society (ERS)
(Celli et al, 2004), which is updated every year by GOLD (GOLD, 2006).
The Global Alliance against Chronic Respiratory Diseases
(GARD) is being developed by the World Health Organization (WHO) together with
respiratory, allergological and general practitioner societies and other
organizations, with the aim of soliciting a global effort to increase COPD
awareness (Bousquet et al, 2007).
Another important initiative aimed at spreading knowledge
on the great problem of respiratory diseases among the general public and
politicians is the European Lung White Book, published by the European
Respiratory Society (ERS) and the European Lung Foundation (ELF) (European
Respiratory Society, 2003). This publication includes the total figures of
mortality, morbidity and costs of COPD. A second edition of the book is going to
be published, in accordance with the new support offered by the EU to the
research on chronic respiratory diseases (MacNee et al, 2007).