COPD case finding and identification of at-risk individuals: opportunities for early personalized intervention and...

A substantial proportion of chronic obstructive pulmonary disease (COPD) cases remain undiagnosed, delaying appropriate care and allowing disease progression. Targeted case finding, particularly in symptomatic individuals and those at risk, offers an opportunity to identify COPD earlier and intervene before irreversible airflow limitation occurs. Recognizing at-risk individuals who exhibit clinical, functional, or structural abnormalities despite normal spirometry expands the potential for disease interception and personalized management. Among the modifiable traits relevant to early COPD, chronic bronchitis represents a clinically meaningful phenotype associated with disease progression and poorer outcomes. This narrative review evaluates current and emerging approaches that enhance COPD case finding and identify individuals at risk of developing the disease. These include functional assessments, imaging modalities, biomarkers, and digital health tools, which together may improve precision in detecting early abnormalities and support timely, individualized intervention strategies. Within this framework, evidence on N-acetylcysteine is described. By integrating refined case-finding strategies with targeted treatment of modifiable traits, earlier and more personalized intervention may be achievable, with the potential to alter disease trajectory and reduce the overall burden of COPD.