It is my pleasure to introduce this excellent monograph in the series Hot Topics in Respiratory Medicine. This monograph deals with early treatment of chronic obstructive pulmonary disease (COPD): from clinical trials to clinical practice. The topic is certainly hot. So far patients with COPD have often only been treated as of Stage III [1]. Recent analyses of the UPLIFT (Understanding Potential Longterm Impacts on Function with Tiotropium) and TORCH (Towards a Revolution in COPD Health)-studies have provided at least strongly suggestive evidence for two essential facts. First, treatment with a long-acting anticholinergic or a fixed combination of a long-acting beta-agonist and an inhaled steroid, produces numerically greater treatment effects in patients with early COPD (GOLD Stage II), than in patients with more advanced disease (GOLD Stage III and IV) [2-4]. Whether indeed the different GOLD stages reflect earlier and more advanced disease is a very interesting point of discussion, recently addressed by Burgel et al [5]. It will not be discussed here as it is clearly beyond the scope of the present publication. Second, indications are present that the disease progresses faster in the early stages of the disease and that treatment in these stages appears to modify the progression of the disease [1-4]. These important concepts emerging from large scale long-term trials, certainly if they would be confirmed in customized long-term trials specifically targeting patients with early COPD, are about to change clinical practice. To treat better requires better diagnosis first. Indeed, many patients with early COPD remain undiagnosed [6]. The present monograph deals with these different aspects, addressed by international experts in the field. First, the prevalence and impact of undiagnosed COPD is dealt with [6]. Then, methods for diagnosis are analyzed, essentially questionnaires and spirometry [7]. Finally, the benefits of early treatment are discussed [8]. We sincerely hope that the present monograph will help physicians understand what can be expected from early treatment and that it will contribute to a shift in treatment paradigm that is about to occur.  

 

REFERENCES

1. Decramer M, Cooper CB. Treatment of COPD: the sooner the better. Thorax 2010;65:837-841.

2. Decramer M, Celli, Kesten S, et al. Effects of Tiotropium on outcomes in patients with moderate chronic obstructive pulmonary disease (UPLIFT): a prespecified subgroup analysis of a randomised controlled trial. Lancet 2009;374:1171-1178.

3. Troosters T, Celli B, Lystig T, et al. Tiotropium as a first maintenance drug in COPD: secondary analysis of the UPLIFT trial. Eur Respir J 2010;36:65-73.

4. Jenkins CR, Jones PW, Calverley PM, et al. Efficacy of salmeterol/fluticasone propionate by GOLD stage of chronic obstructive pulmonary disease: analysis from the randomised, placebo-controlled TORCH study. Respir Res 2009;10:59.

5. Burgel PR, Paillasseur JL, Caillaud D, et al; on behalf of the Initiatives BPCO Scientific Committee. Clinical COPD phenotypes: a novel approach using principal component and cluster analyses. ERJ 2010;36:531-539.

6. Llor C. Prevalence and impact of undiagnosed chronic obstructive pulmonary disease. Monograph. Hot Topics Respir Med 2010;5(14):9-12.

7. Price D. Spirometry and questionnaire use to for earlier diagnosis of chronic obstructive pulmonary disease. Monograph. Hot Topics Respir Med 2010;5(14):13-18.

8. Roman-Rodriguez M. Early treatment benefits in chronic obstructive pulmonary disease. Monograph. Hot Topics Respir Med 2010;5(14):19-26.