Success in the diagnosis, prevention, and treatment of COPD is at an all-time high in 2018. Still, gaps remain in the recommendations for certain aspects of care due to contradictory evidence in current medical literature.

The widely accepted global reference for the diagnosis and treatment of patients—the 2017 major update of the Global Obstructive Lung Disease Initiative (GOLD) Report—addresses controversies in COPD care. These controversies include the diagnosis and assessment of COPD, risk factors for disease development, advances in treatment of the stable patient, and the assessment and treatment of exacerbations.

“We hope to initiate and spur a creative, multidisciplinary approach to addressing these gaps in current knowledge, as well as a sustained dialogue about the issues,” says Gerard J. Criner, MD, chair of thoracic medicine and surgery at Temple University Hospital.

Among Dr. Criner’s objectives is to examine whether airflow obstruction is necessary to diagnose and treat COPD. For example, airflow limitation, or spirometric obstruction, must be present when diagnosing COPD. However, in recent studies, similar respiratory symptoms without airflow obstruction have been seen in patients who smoke. Patients indicate the symptoms are severe and negatively impact their quality of life. Therefore, clinicians have posed the question as to whether these patients suffer from COPD, and whether it’s necessary to diagnose COPD without the presence of airflow obstruction.

Gerard Criner, MD

Another controversy, according to Dr. Criner, is whether a personalized treatment plan for COPD is feasible. Genetic and environmental influences differ in patients diagnosed with COPD, which suggests selected treatments may be a better approach to care.

“More research is needed to discover tools that can enhance phenotypic characterization, especially in the area of blood biomarkers, such as peripheral eosinophils for the diagnosis, prognosis, and response to therapy,” Dr. Criner says.

Finally, the session will explore whether the medical community needs a new concept or definition of what constitutes an exacerbation of COPD. Current definitions of exacerbations of COPD are restricted to examining the frequency of symptoms, non-specificity of symptoms for lung versus cardiac origin, and the differences in clinician responses to the patient’s report of symptoms. The issue with the current definition is that it lacks an objective biomarker that indicates the onset of COPD, as well as its severity and prognosis. Current discussion focuses on the need to develop a simple and objective definition of exacerbation that incorporates symptom change with biomarker characterization.

Dr. Criner also says it’s important for clinicians to determine whether the cause of a COPD exacerbation is pulmonary or non-pulmonary to better treat the disease.  Bacterial causes would support the use of antibiotics, while acute exacerbations are limited to increased use of short-acting bronchodilators, systemic glucocorticoids, and antibiotics. Novel and more effective treatments are necessary to treat the infections, inflammation, and oxidative stress that occur during an acute exacerbation.

Controversies in the Diagnosis and Treatment of COPD (B82) is supported by educational grants from AstraZeneca LP, GlaxoSmithKline, and Sunovion Pharmaceuticals Inc.