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Asymptomatic COPD, until you take it to exertion
  1. Lowie E G W Vanfleteren
  1. Correspondence to Dr Lowie E G W Vanfleteren, Department of Research and Development, CIRO, Center of expertise for chronic organ failure, Hornerheide 1 Horn 6085NM, The Netherlands; lowievanfleteren{at}ciro-horn.nl

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COPD is a growing problem worldwide, with a staggering high number of affected subjects1 and a huge burden for society in terms of days of work lost and healthcare costs.2 COPD is closely related to smoking, and continued smoking in patients with COPD is associated with further deterioration in lung function.3 Despite elaborate societal preventive measures and smoking discouragement campaigns, smoking prevalence is still high and adolescents and young adults still start smoking. Although WHO reports a declining smoking prevalence worldwide and in many countries, there were still over 1.1 billion people who smoked tobacco in 2015.4 A population-based cohort study (inclusion 2007–2009) in adults aged more than 40 years in the Netherlands, for example, showed that overall smoking prevalence was 23% and only 34% were never smokers.5 Population surveys from 2012 in the Netherlands in age 20+ showed a similar 23% of smokers and 18% of adolescents (10–19 years) reported to have smoked in the last 4 weeks.6 Hence, despite all the efforts, smoking is still universally present and COPD continues to rise in ‘cause of death’ tables. In 2012, it was ranked third after ischaemic heart disease and stroke.7

An early diagnosis of COPD is warranted for maximal intervention in an early phase, including improving health behaviour, physical activity, smoking cessation and potential pharmacological treatment. Unfortunately, the prevalence of underdiagnosis of COPD is universally high as shown by the international Burden of Obstructive Lung Disease (BOLD) study that systematically evaluated subjects older than 40 years in the general population using standardised spirometry.8 Case-finding …

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