5.8.5. Control tools and policies

Primary prevention

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 stage.

Secondary prevention

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 10 pack-yrs. 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.

Policies

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).