World COPD Day

World COPD Day is a global event organized by the Global Initiative for Chronic Obstructive Lung Disease (GOLD) in collaboration with health care professionals and COPD patient groups throughout the world. Its aim is to raise awareness, share knowledge, and discuss ways to reduce the burden of chronic obstructive pulmonary disease (COPD) worldwide. Since its inception, World COPD Day has been a critical platform for advocating for better lung health and reducing the global impact of COPD.

To better understand why this day is important, we spoke to Dr Ioanna Tsiligianni who is Associate Professor of the Department of Social Medicine at the University of Crete, and Editor in Chief for the journal npj Primary Care Respiratory Medicine. Dr Tsiligianni's areas of interest focus on primary care and public health. Her research is mainly related to COPD and asthma, health status, comorbidities and frailty. She also coordinated the development of the first national guidelines for primary care on COPD and asthma in Greece.

GOLD 2023 defines COPD as a heterogeneous lung condition characterized by chronic respiratory symptoms (dyspnoea, cough, expectoration and/or exacerbations) due to abnormalities of the airways (bronchitis, bronchiolitis) and/or alveoli (emphysema) that cause persistent, often progressive, airflow obstruction (FEV1/FVC<0.7)1. This definition aims at: (1) recognizing that COPD is heterogeneous; and (2) describing explicitly what are the main structural, functional, and clinical manifestations of the disease.

Smoking and air pollution are the most common causes of COPD. People with COPD are at higher risk of other health problems. 

COPD is not curable, but symptoms can improve if one avoids smoking and exposure to air pollution and gets vaccines to prevent infections. Bronchodilators and pulmonary rehabilitation improve symptoms, quality of life and reduce unwanted outcomes. 

Several processes can cause the airways to become narrow and lead to COPD. There may be destruction of parts of the lung, mucus blocking the airways, and inflammation and swelling of the airway lining.

COPD develops gradually over time, often resulting from a combination of risk factors:

• tobacco exposure from active smoking or passive exposure to second-hand smoke;
• occupational exposure to dusts, fumes or chemicals;
• indoor air pollution: biomass fuel (wood, animal dung, crop residue) or coal is frequently used for cooking and heating in low- and middle-income countries with high levels of smoke exposure; 
• early life events such as poor growth in utero, prematurity, and frequent or severe respiratory infections in childhood that prevent maximum lung growth;
• asthma in childhood; and
• a rare genetic condition called alpha-1 antitrypsin deficiency, which can cause COPD at a young age.

COPD should be suspected if a person has typical symptoms, and the diagnosis confirmed by spirometry, when FEV1/FVC<0.70 after bronchodilation. In low- and middle-income countries, spirometry is often not available and so the diagnosis may be missed. Many challenges in performing and interpreting results have been reported in primary care.

COPD is a prevalent disease requiring a multidimensional assessment and holistic approach to management over time. People with COPD often suffer from anxiety and depression and are also frail and therefore clinicians should be ready to treat these important comorbidities.

This need for holistic, continuous and local care explains why COPD is important for primary care. People present with common symptoms such as breathlessness, cough and fatigue. Multi-morbidity is the norm with nearly half of people with COPD having three or more additional diagnoses; in only one in five patients will COPD be an isolated disorder, emphasising the need for a holistic approach.

Multi-disciplinary primary healthcare professionals are at the forefront of care in the diagnosis and management of COPD in many countries. At different stages, people with COPD may benefit from the skills of specialist respiratory teams and social services. The role of primary care is, however, pivotal throughout, providing continuity of care and a generalist oversight to ensure that the patient’s individual needs remain the central focus.

The most common symptoms of COPD are difficulty breathing, chronic cough (sometimes with phlegm) and feeling tired. The level of awareness is high in many other chronic diseases but unfortunately this isn’t the case of COPD.

The role of public health and primary care to increase awareness is crucial. People that smoke should know that they are at a higher risk of developing COPD and seek for assistance in stop smoking. Same happens also with other risk factors e.g. people should know about indoor pollution and the need to improve indoor air quality.

Primary care physicians should always start from smoking cessation using techniques like Very brief Advice, and be ready to perform or refer for spirometry. Microspirometers and questionnaires to assess the risk for COPD can be easily applied.

COPD is typically diagnosed based on a combination of patient history, physical examination, and lung function testing. The Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines recommend the following steps:

• Patient history: Assess symptoms, smoking history, and exposure to pollutants.
• Physical examination: Evaluate lung sounds, wheezing, and signs of respiratory distress.
• Spirometry: Measure forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC) to assess lung function.
• Bronchodilator reversibility testing: Administer a bronchodilator and re-assess lung function to determine if airflow improves.FEV1/FVC<0.70 confirms the diagnosis.

Underdiagnosis of COPD is a persistent problem worldwide and continues to be a major reason for the undertreatment of the condition despite the availability of effective non-pharmacotherapeutic and pharmacotherapeutic interventions. 

IPCRG has developed a quick guide to spirometry which is available in Spanish, Portuguese, Italian, Greek, Chinese and Vietnamese. This desktop helper aims to provide primary care professionals with the information they need to prepare for, conduct, evaluate and interpret spirometry and understand its role and limitations in the diagnosis and monitoring of respiratory disease.

IPCRG’s new Spirometry Simplified educational package created by a global multidisciplinary expert faculty including self-paced e-learning, in person masterclass tailored to the needs of primary care physicians, portfolio assessment and mentoring as required. The next masterclass will held in April 2024 at the 8th IPCRG Scientific Meeting taking place in Brașov, Romania.

The Global Initiative for Chronic Obstructive Lung Disease (GOLD) issues an annual report. There were significant changes in 2023, and therefore we commissioned a summary of the most relevant changes for a primary care audience. 

It remains the case that disease-specific guidelines typically base recommendations on trials which often exclude patients with significant co-morbidity, limiting application in real-life practice. This can lead to problems that affect quality of life such as polypharmacy and/or contradictory advice that may confuse the patient. 

Primary care clinicians often don’t know how to approach a patient with multimorbidity, and they need to have the skill and support to decide when patients with comorbid disease are and are not likely to benefit from guideline recommendations. To this direction IPCRG has produced material to support these decisions.

The IPCRG has co-produced a set of 10 statements that answer the question “what does good COPD care look like” from the perspective of primary care .  Many of IPCRG’s resources support the delivery of these quality statements.

In 2021 as part of IPCRG’s social movement to raise awareness about right care for people with COPD,  COPD Right Care, a new tool, the COPD Wheel was developed by a multidisciplinary team from 6 countries  to help start new conversations about personalising care for people with COPD.

This resource complements IPCRG’s new (September 2024) Question & Challenge Cards. These can be used at individual, practice, undergraduate or postgraduate teaching level to raise awareness and discussion about the prevention, diagnosis and management of COPD. They feature individual questions and challenging statements with referenced answers. Many incorporate infographics and can therefore also be used in social media campaigns.  

First of all, raise awareness on any occasion. Collaborate with public health authorities to support campaigns and with international organisations as IPCRG to promote the message that COPD is a prevalent disease that influences the quality of life of patients and can lead to adverse outcomes such as exacerbations, hospitalisations, lower capacity in exercise etc.

Try to help patients quit smoking; try showing them the impact on their lung health. Try to perform and interpret spirometry in primary care, now it's easier with the IPCRG spirometry course available. Always assess quality of life and exacerbations, vaccinations, check inhalation technique, and use an individualised action plan based also on comorbidities.

To the patients; ask for help to stop smoking to avoid COPD development, and if you have COPD already, to reduce symptoms, exacerbations and have a better quality of life. Take your medications, and  if you don’t know how to use the inhalers do ask your primary care team; take your vaccinations as suggested, be active and have a good diet as suggested in IPCRG material. Be active in the management of your disease and collaborate with your primary care team.