title: Health and social impacts of COPD and the problem of under-diagnosis.
abstract: This article deals with the prevalence and the possible reasons of COPD underestimation in the population and gives suggestions on how to overcome the obstacles and make the correct diagnosis in order to provide the patients with the appropriate therapy. COPD is diagnosed in later or very advanced stages. In Italy the rate of COPD under-diagnosis ranges between 25 and 50% and, as a consequence, the patient does not consult his doctor until the symptoms have worsened, mainly due to exacerbations. A missed diagnosis influences the timing of therapeutic intervention, thus contributing to the evolution into more severe stages of the illness. An incisive intervention to limit under-diagnosis cannot act only in remittance (passive diagnosis), but must be the promoter for a series of preventive actions: primary, secondary and rehabilitative. To reduce under-diagnosis, some actions need to be taken, such as screening programs for smokers subjects, use of questionnaires aimed to qualify and monitor the disease severity, spirometry, early diagnosis. There is a consensus regarding diagnoses based on screening of at-risk subjects and symptoms, rather than screening of the general population. In practice, all individuals over 40 years of age with risk factors should make a spirometry test. Screening actions on a national scale can be the following: compilation of questionnaires in waiting rooms of doctor's offices or performing simple maneuvers to evaluate the expiratory force at pharmacies. It is now widely recognized that COPD is a complex syndrome with several pulmonary and extrapulmonary components; as a result, the airway obstruction as assessed by FEV1 by itself does not adequately describe the complexity of the disease and FEV1 cannot be used alone for the optimal diagnosis, assessment, and management of the disease. The identification and subsequent grouping of key elements of the COPD syndrome into clinically meaningful and useful subgroups (phenotypes) can guide therapy more effectively. In conclusion, we firmly believe that an early and correct diagnosis can influence positively the progress of the disease (lowering the lung function impairment), decrease the risk of exacerbations, relieve symptoms and increase the patients' quality of life leading also to a decrease in costs associated to the exacerbations and hospitalization of the patient.
authors.affiliation: Pulmonary Department, San Giovanni-Addolorata General Hospital, Rome, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Carlone
authors.affiliation: Pulmonary Rehabilitation Department, IRCCS Fondazione Salvatore Maugeri, Veruno (NO), Italy.
authors.forename: Bruno
authors.initials: B
authors.lastname: Balbi
authors.affiliation: Endoscopy and Laser Therapy, Respiratory Unit, Hospital of Brescia, Brescia, Italy.
authors.forename: Michela
authors.initials: M
authors.lastname: Bezzi
authors.affiliation: Respiratory Pathophysiology and Rehabilitation Unit, Policlinico Umberto I, Rome, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Brunori
authors.affiliation: Respiratory Unit, San Bassano Hospital, Bassano del Grappa, Vicenza Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Calabro
authors.affiliation: Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy.
authors.forename: Maria Pia
authors.initials: MP
authors.lastname: Foschino Barbaro
authors.affiliation: Respiratory Unit, Mater Salutis Hospital, Legnago, Verona Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Micheletto
authors.affiliation: Centre for Prevention and Monitoring Respiratory Failure, ASP, Catania, Italy.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Privitera
authors.affiliation: Respiratory Function and Sleep Laboratory, AOU S. Luigi, Orbassano (TO), Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Torchio
authors.affiliation: Physiopatology Respiratory Unit, General Hospital F. Miulli, Acquaviva delle Fonti (BA), Italy.
authors.forename: Pietro
authors.initials: P
authors.lastname: Schino
authors.affiliation: Respiratory Pathophysiology Division, University-City Hospital of Padova, Padova, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Vianello
keywords: COPD; Early diagnosis; Indicators; Phenotype; Spirometry; Underestimation