COPD is an ancient condition, but was not defined in the way we understand it today until the relatively recent GOLD criteria. The definition is not based on the WHO criteria of chronic bronchitis, i.e., “daily cough and sputum for at least three months in each of two consecutive years.”
The definition is now based on a spirometric criterion (Tiffeneau index = FEV1/FVC <70%) and a history that the patient has been exposed to inhaled noxious agents.
This definition underscores how important it is in family practice today to be able to perform spirometry. If no spirometer is available, the patient must be sent to a specialist already for diagnosis.
An early diagnosis of COPD is only possible if a screening spirometry is performed in subjectively still asymptomatic smokers at the age of 40 years, which then objectifies premature lung aging in pathological cases.
Spirometry is also indispensable for the therapy of asthma: The international GINA guidelines of asthma stipulate that the degree of current asthma control be determined during a physician contact. Asthma control criteria include current FEV1 in addition to symptom-specific questions.
Spirometers are therefore an indispensable part of a modern family practice!
Similar to asthma, different clinical pictures are now subsumed under the diagnosis of COPD: COPD with bronchitic symptoms, with emphysema, with frequent exacerbations, and with an asthma component. By recognizing specific COPD phenotypes, therapy becomes more targeted and phenotype-specific. Thus, the former marketing strategy “inhaled combination preparations (topical steroid and long-acting beta stimulator) for all patients with asthma and COPD” is obsolete: In many cases, the therapy must be more differentiated!
Thomas Rothe, MD
