Diagnosis criteria for COPD should be expanded to include CT scan, other factors

Lung treatment experts are advocating for the widespread use of CT scans to help better diagnose and treat chronic obstructive pulmonary disease. Doing so could potentially add millions of new diagnoses of the condition each year, but also help clinicians to catch its progression earlier in the disease process.

Researchers made their case in a recently published special edition of the Journal of the COPD Foundation. COPD currently affects about 12 million people in the U.S. each year. But by focusing on a single measure of lung function, diagnosticians may be missing millions more cases, wrote James Crapo, MD, a pulmonologist at Denver-based National Jewish Health, and colleagues.

They’re advocating to expand diagnostic criteria to also include environmental factors such as smoking, symptoms (i.e., shortness of breath), structural abnormalities found on CT scans (airway wall thickness) and lung-function testing. This change could potentially boost COPD diagnoses by 15% to 36% annually, adding upward of 5 million cases to its totals, Crapo and colleagues estimated.

“Our proposed diagnostic criteria better capture the full spectrum of people suffering from COPD,” he said in a statement issued Nov. 12. “This can lead to better care for patients and stimulate research to slow or stop progression of the disease or even prevent it.”

To back up their argument, the authors evaluated nearly 9,000 former and current smokers enrolled in their COPDGene study. They documented their environmental exposures, symptoms, abnormalities on CT scan and lung function at enrollment, and then correlated those findings with mortality and loss of lung function five years later.

Those meeting one, two or three of the added criteria had an increased risk of losing lung function or dying, they found. In particular, smokers who met two of the three criteria had an 88% greater chance of losing normal lung use, and an 89% greater chance of dying. Those numbers ballooned to 188% and five-times the risk of death, respectively, when meeting all four criteria.

Expanding the diagnostic toolbox would mean more individuals meet the requirements to take part in COPD clinical trials for experimental therapies, Crapo noted. This could, in turn, fuel further research to help slow or prevent COPD’s progression.

“If we diagnose COPD based only on impaired lung function, then we miss many patients in the early stages of the disease,” he added. “While some physicians do empirically treat patients with symptoms, many patients are not getting therapy that can improve their symptoms, their quality of life and might extend their lives.”