What we're still missing for early COPD diagnosis and care
Key Takeaways
Early detection of COPD is imperative to improve your patient's quality of life while reducing their symptom burden, but diagnosis remains a challenge.
Primary factors impacting early diagnosis include overlooking mild symptoms and challenges related to screening recommendations.
Both patients and physicians must be vigilant in recognizing early signs of COPD and consider a range of risk factors—beyond smoking—to ensure comprehensive evaluation and diagnosis of COPD.
Despite being one of the leading causes of morbidity and mortality globally, approximately 70%–80% of adults with chronic obstructive pulmonary disease (COPD) go unidentified.[]
"We need better awareness, both among physicians and patients, to catch the disease early."
— Alok Mohta, MD, MBBS
Early diagnosis
“The underdiagnosis is mainly because early symptoms are subtle, and spirometry, the gold standard, is not used widely enough in routine care,” Alok Mohta, MD, MBBS, tells MDLinx. Dr. Mohta is a board-certified physician at the Infectious Diseases Institute, Dr. Sampurnanand Medical College, Jodhpur, India, with over 30 years of experience treating COPD.
In a 2024 study, early diagnosis and guideline-based treatment of undiagnosed COPD significantly reduced healthcare utilization for respiratory illness.[] It also improved quality of life, reduced symptom burden, and yielded better lung function compared to usual care. However, effective early detection remains a challenge.
Gold standard testing
Spirometry, despite being a vital tool, is underutilized. One study found that only around 37% of newly diagnosed COPD patients had undergone spirometry testing. The reasons are cost of the spirometer, lack of expertise, and problems with access, particularly in primary care settings, where the cost of the test may be prohibitive for some patients.
Dr. Mohta adds, “While alternative simpler tools like handheld devices are available, they are not a common part of routine diagnostics yet.”
Another issue is recognizing early signs of COPD. Both patients and doctors often dismiss mild symptoms like occasional shortness of breath. “Most patients come to me when their symptoms are severe,” Dr. Mohta says.
"They’ve had mild respiratory issues for years, but it wasn’t bad enough to seek help. That’s where we lose the chance for early intervention."
— Alok Mohta, MD, MBBS
Raj Dasgupta, MD, a board-certified physician specializing in internal medicine and pulmonology, explains, "The United States Preventive Services Task Force (USPSTF) currently recommends against screening for COPD in asymptomatic individuals. This recommendation does not apply to adults who present with symptoms, such as chronic cough or dyspnea.”
"One of the main challenges to early diagnosis of COPD is not having standardized recommendations in regards to screening for COPD."
— Raj Dasgupta, MD
Expanded understanding of causes
While smoking is still a major factor, environmental contributors like air pollution and biomass exposure are becoming significant risks. According to authors of a review from the International Journal of Chronic Obstructive Pulmonary Disease, delayed diagnosis is also due to both patients and physicians focusing too narrowly on smoking as the only risk factor.[]
There is a growing understanding that lung function, shaped by environmental and genetic factors throughout life, plays a major role in COPD development.
“I see patients who’ve never smoked a day in their life but have COPD due to chronic workplace exposure to dust or heating fuels without ventilation and secondhand smoke or poor air quality,” Dr. Mohta explains.
What this means for you
Despite being a leading cause of morbidity and mortality worldwide, the majority of adults with COPD remain undiagnosed. This is primarily due to subtle early symptoms and a lack of standardized screening recommendations. Other challenges include the tendency for both patients and doctors to ignore mild symptoms while overlooking environmental factors that contribute to the disease, such as air pollution and workplace exposures.