The global prevalence for COPD using the GOLD criteria is very high (about 10%) for people within the age of 30-79 years. In clinical practice COPD is often understood as a single disease of symptomatic cigarette smoker with airflow obstruction assessed by spirometry. So far diagnosis and classification are mainly based on spirometry. ERS/ATS reported 2017 changes in the technical standards related to diffusion capacity for carbon monoxide (DLco) measurement with the use rapidly responding gas analysers. Portable devices, allowing the measurements of spirometry, DLco and lung volumes outside of hospital-based pulmonary function laboratories open the access to more patients. However, other available lung function parameters as diffusion capacity also offer substantial physiological information, which allow a better classification of patients with COPD. In addition, advanced pulmonary lung function testing may open the door for identifying pulmonary and/or extrapulmonary comorbidities.
We believe that lung function testing beyond spirometry may improve the understanding of physiological pulmonary dysfunction but are not included in the recommended diagnostic workup for patients with COPD: Especially the single breath DLco among the physiological parameters offers valuable information in patients with COPD. Indeed, several studies showed in patients with moderate to severe airflow obstruction that DLco are associated with increased symptoms, reduced exercise capacity and mortality. This seems to also the case in mild disease where decreased DLco has been associated even with increased mortality. Therefore, we believe that other function testing such as DLco needs to be further evaluated to identify different clinical meaningful phenotypes of COPD not detected by spirometry.
In the collection of papers, we aim to include research about different diagnostic tolls to evaluate patients with COPD. This will include papers on different functional testing of the lung in addition to lung imaging. The aims are to collect different methodological approaches to better define COPD patients and classify them into different clinical meaningful phenotypes. It is time to use portable lung function devices for combined spirometry and DLco. This should be the first step to identify the heterogeneity of COPD. In addition, advanced pulmonary lung function testing may open the door for early identifying pulmonary and/or extrapulmonary comorbidities. This step forward should improve our collaboration between different medical disciplines for example pneumology, cardiology, rheumatology, immunology, and infective diseases.
We welcome original research as well as review articles.
Keywords
- COPD
- lung function
- diagnostics
- diffusion capacity
- disease phenotyping
