Many years ago, Chronic Obstructive Pulmonary Disease (COPD) was considered to be a conglomerate of syndromes mainly manifested as Chronic Bronchitis or Emphysema. At some point it was made clear that most COPD patients, in fact had both “forms” of the disease. Perhaps one was predominant in some, while the other was obvious in others. Some confusion appeared among some practitioners and there was need to look for some clarity. Why not all COPD patients look the same? Why some have a slower progression? Why some cough up phlegm in the morning while others don’t?
Each Patient is Different
Each patient is different and it is more obvious that each COPD patient is different from another. Some patients have more flare ups (exacerbations) per year. Some patients develop cardiovascular complications and others require long-term Oxygen therapy (LTOT) earlier. There are some who get exhausted during activities of daily living while some (with the same lung function results) just … do real physical exercise.
Recent Investigations on COPD diversity
The ECLIPSE cohort (more than 2000 individuals with COPD) was assessed by a group of investigators looking for diversity among disease manifestation. It was interesting to see that Lung Function Tests (FEV1) was “poorly related to the degree of breathlessness, health status, presence of co-morbidity, exercise capacity and number of exacerbations reported in the year before the study”. This means that the compromise seen in the FEV1 value may not predict the intensity of the fatigue, existence of other diseases, tolerance of physical activity or number of flare-ups.
What it means
The reason for this disparity might be because some patients may be more prone to develop more breathlessness than others. Some may develop complications easier or even be frequent exacerbators. Those type of details are necessary to be discussed by patients and physicians to understand the management they are sharing as well as what to expect during the course of the disease since there are different trends in the common clinical course of this condition.
The role of physicians and patients on COPD diversity
It will be important for patients to discuss with physicians analysis on where they fit among the diverse population of COPDers. Because not all COPD patients are the same, the patient might need to describe themselves with some more detail to support more individual decisions on therapy and follow up. It is getting clearer that COPD is a more delicate condition with more details to unveil. It is necessary for physicians to get more sense of their patients to help educate them on their disease and what is around most corners.
The airflow limitation is common but there is more than that in the disease
One thing seems to be clear: there is a physiologic disturbance (decreased FEV1 or air flow limitation) with potential consequences and potential associated events with a frequency and severity that varies and that could be prevented and/or treated. Let’s face it: there is clear guidance on the management approach but there is uncertainty on what is the definite look of the patients and what to wait for in the settlement of the condition. Because … each COPD might be really different.