Early COPD: how to identify it and is it worth treating?

It is worthwhile identifying patients with mild COPD and early disease, but this is possible only if case finding occurs in primary care. Detection of airflow limitation when the patient is asymptomatic and confirmation by spirometry of a diagnosis of COPD identifies individuals at risk of future symptoms and complications of the condition. Better stratification of future risk by actively diagnosing COPD may alter the management in individuals who have additional risk factors for COPD progression and a cardiovascular risk. Performing spirometry in current smokers may increase their chances of smoking cessation. It is important to recognise that when a previously asymptomatic patient with newly diagnosed airflow limitation develops respiratory symptoms, this represents an exacerbation of COPD. This exacerbation needs to be managed accordingly, and not be misdiagnosed as a simple lower respiratory tract infection. Confirmation or exclusion of COPD allows appropriate drug prescription and helps avoid diagnostic confusion. Management of COPD, including its pharmacotherapy, continues to evolve as understanding of the condition increases, particularly the appreciation of the heterogeneity of the disease. Case finding of COPD raises complex arguments about cost effectiveness, clinical benefit and appropriate treatment. There are a great number of clinical questions that still need answering by well-designed clinical studies to provide a stronger evidence base to guide management in early COPD.