Despite being one of the leading causes of morbidity and mortality globally, approximately 70%–80% of adults with chronic obstructive pulmonary disease (COPD) go unidentified.

Lin CH, Cheng SL, Chen CZ, et al. Current progress of COPD early detection: key points and novel strategies. Int J Chron Obstruct Pulmon Dis. 2023;18:1511–1524.

 

We need better awareness, both among physicians and patients, to catch the disease early.

 

Early diagnosis

 

“The underdiagnosis is mainly because early symptoms are subtle, and spirometry, the gold standard, is not used widely enough in routine care,” Alok Mohta, MD, MBBS, tells MDLinx. Dr. Mohta is a board-certified physician at the Infectious Diseases Institute, Dr. Sampurnanand Medical College, Jodhpur, India, with over 30 years of experience treating COPD.

In a 2024 study, early diagnosis and guideline-based treatment of undiagnosed COPD significantly reduced healthcare utilization for respiratory illness.

Aaron SD, Vandemheen KL, Whitmore GA, et al. Early diagnosis and treatment of COPD and asthma - a randomized, controlled trial. N Engl J Med. 2024;390(22):2061–2073.

It also improved quality of life, reduced symptom burden, and yielded better lung function compared to usual care. However, effective early detection remains a challenge. 

 

 

Gold standard testing

 

Dr. Mohta adds, “While alternative simpler tools like handheld devices are available, they are not a common part of routine diagnostics yet.” 

Another issue is recognizing early signs of COPD. Both patients and doctors often dismiss mild symptoms like occasional shortness of breath. “Most patients come to me when their symptoms are severe,” Dr. Mohta says.

They’ve had mild respiratory issues for years, but it wasn’t bad enough to seek help. That’s where we lose the chance for early intervention.

Raj Dasgupta, MD, a board-certified physician specializing in internal medicine and pulmonology, explains, “One of the main challenges to early diagnosis of COPD is not having standardized recommendations in regards to screening for COPD. The United States Preventive Services Task Force (USPSTF) currently recommends against screening for COPD in asymptomatic individuals. This recommendation does not apply to adults who present with symptoms, such as chronic cough or dyspnea.”

Unfortunately, many major clinical practice guidelines recommend against routine general screening for COPD in asymptomatic individuals.

 

Expanded understanding of causes

 

While smoking is still a major factor, environmental contributors like air pollution and biomass exposure are becoming significant risks. According to authors of a review from the International Journal of Chronic Obstructive Pulmonary Disease, delayed diagnosis is also due to both patients and physicians focusing too narrowly on smoking as the only risk factor.

Lin CH, Cheng SL, Chen CZ, et al. Current progress of COPD early detection: key points and novel strategies. Int J Chron Obstruct Pulmon Dis. 2023;18:1511–1524.

 

“I see patients who’ve never smoked a day in their life but have COPD due to chronic workplace exposure to dust or heating fuels without ventilation and secondhand smoke or poor air quality,” Dr. Mohta explains.