Pre-COPD: an evolving concept with practice potential

Abstract

COPD is the third leading cause of death globally and remains a major public health burden. Despite its substantial impact, effective prevention remains challenging. COPD is currently defined as having FEV₁/FVC below lower limit of normal or 0.7 in a person with known risk factors. However, this formal diagnosis occurs only after significant loss of lung function and the onset of persistent symptoms. These symptoms, rather than pathophysiological changes, are what typically prompt patients to seek medical care. Even then, many are not offered spirometry, further delaying diagnosis until acute exacerbations or a level of dyspnoea that impacts daily life prompt clinical attention. By this point, more than 50% of individual’s FEV₁ has often been lost and treatment becomes largely palliative. This situation highlights a pressing need for earlier identification of lung damage associated to a later diagnosis of COPD; this is needed in its early “silent” phase, when there might be an opportunity to change the course of disease with preventive interventions.