A leading Australian thoracic specialist and researcher has called for a revision of current COPD criteria to include cough and sputum as red flags for the disease.
Professor Christine Jenkins, head of Respiratory Trials at The George institute for Global Health, Senior Staff Specialist in Thoracic Medicine at Concord Hospital, Sydney, and Clinical Professor and Head of Respiratory Discipline at the University of Sydney, says not all patients with early-stage disease will meet the spirometry criteria for a diagnosis of COPD.
She said smokers and ex-smokers were particularly likely to be symptomatic – with cough and sputum – but not meet the spirometry criteria for COPD.
“I think the symptoms are telling us something really really important,” she told the limbic.
“Even if they (patients) don’t meet the spirometry criteria they might still have COPD – they just don’t yet meet all the symptom criteria. It looks as if these people are on a trajectory – and it does tell you that they have symptoms and you can intervene.”
Professor Jenkins was commenting on an observational study published in the New England Journal of Medicine which supports this.
“Currently, the diagnosis of chronic obstructive pulmonary disease (COPD) requires a ratio of forced expiratory volume in 1 second (FEV1) to forced vital capacity (FVC) of less than 0.70 as assessed by spirometry after bronchodilator use,” the authors wrote.
“However, many smokers who do not meet this definition have respiratory symptoms.”
The researchers found respiratory symptoms were present in 50% of current or former smokers with preserved pulmonary function. Among symptomatic current or former smokers, 42% used bronchodilators and 23% used inhaled glucocorticoids.