Beyond spirometry: understanding COPD origins to support a new diagnostic approach

Area of Science:

• Pulmonary Medicine
• Diagnostic Imaging
• Biomarker Discovery

Background:

• Chronic obstructive pulmonary disease (COPD) is a major cause of death, with current diagnostic methods like spirometry identifying disease only after irreversible lung damage.
• Pathogenic processes of COPD begin decades before detection by spirometry, necessitating earlier diagnostic approaches.

Purpose of the Study:

• To review early pathogenic processes in COPD and their potential to inform new diagnostic and treatment strategies.
• To advocate for a shift from spirometry-centric diagnosis to a multidimensional framework.

Main Methods:

• Review of literature on developmental, environmental, genetic, and epigenetic factors in COPD initiation.
• Evaluation of advanced imaging techniques (parametric response mapping, hyperpolarized gas MRI, CT vascular metrics).
• Assessment of physiological tools (forced oscillation, capnography) and biofluid-based platforms (breath analysis, biomarkers).

Main Results:

• Early COPD pathogenesis involves convergent mechanisms leading to structural and functional changes.
• Advanced imaging, physiological tests, and biomarkers can detect abnormalities before spirometric thresholds are met.
• Multidimensional diagnostic approaches integrating various data types identify high-risk individuals missed by spirometry alone.

Conclusions:

• A multidimensional diagnostic framework integrating imaging, physiological, and biomarker data is crucial for early COPD detection.
• Proactive detection in earliest stages is essential to alter disease trajectory and improve patient outcomes.
• Moving beyond spirometry is necessary to achieve better COPD management and patient results.