COPD--moving beyond bronchodilation

The burden of chronic obstructive pulmonary disease (COPD) remains very high. Till recently clinical approach of COPD patients was focused on measuring airflow limitation during exercise and treating airway obstruction with inhaled bronchodilators and corticosteroids. This approach stems from an old definition of COPD, mainly consisting of airflow limitation with poor reversibility after bronchodilation. The concept of COPD has changed strikingly in the last years. Many recent studies have shown that COPD is a systemic disease affecting not only the lungs but many other organs of the patient. Laboratory cardiopulmonary exercise testing assesses physiological and biological reserves. However, it is not the most suitable test to assess the functional state of a systemic disease such as COPD. We need simpler exercise tests that can be used on larger scales. The 6-minute walk test has been shown to be highly reproducible and reflects real life limitations of these patients better. It allows precise measurements of medical intervention and is a good predictor of mortality, provided clinicians respect the defined standards of this test. It should be associated with a more systemic index such as the BODE index to better find disease-modifying interventions and improve the outcome of COPD patients. On the other hand routine measurement of spirometry in the general population by primary care physicians should be promoted as it decreases smoking habits and helps better detecting and management of COPD patients. Specialists should support primary care physicians to spread these new concepts of COPD throughout the medical community.