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An international symposium in Florence on chronic obstructive pulmonary disease
The presence of five easily recognizable conditions give rise to the suspicion of the existence of this respiratory disease

FLORENCE, 27 JUNE 2016–From the simplest exam to the most complex: there are various diagnostic means available for early identification of chronic obstructive pulmonary disease, or COPD, a respiratory disease, which together with asthma, represents one of the main causes of a reduced quality of life and mortality.Advanced age, cigarette smoking, cough, catarrh, shortness of breath even with the slightest effort: these are the conditions that should make us suspect the presence of COPD. Yet COPD is a disease that is very little diagnosed, or only in the advanced stages. This is due to scarce attention by patients, but also by physicians, to the symptoms that often exist for many years (cough or expectoration) and which are considered “normal” in smoking patients, while an accurate clinical assessment could allow the physician to suspect bronchial obstruction and refer the patient to have exams to confirm the suspected diagnosis, thus enabling the earliest possible therapeutic intervention.

This topic was discussed at the“International Symposium on COPD”held in Florence from 23 to 25 June 2016.Leading Italian and international experts met to discuss the diagnosis of chronic obstructive pulmonary disease and how much spirometry, the first diagnostic exam conducted by physicians, can tell us. There were also talks on the novelties offered by genetics and the future prospects of treatment thanks to personalized therapies.The Symposium was organized by the Department of Experimental and Clinical Medicine of the University of Florence and promoted by the Fondazione Internazionale Menarini.

“The first, simplest and most immediate diagnostic test is spirometry, which makes it possible to measure the quantity of air a person can inhale and exhale, and the time these actions both take”,explains Massimo Pistolesi, Professor of the Department of Diseases of Respiratory Tract at the University of Florence and Chairman of the symposium.

A recent project financed by the CCM of the Ministry of Health, entitled “Optimization of the preventive, diagnostic and therapeutic strategies of chronic obstructive pulmonary disease”, concluded in 2010 at the University of Florence, demonstrated how the conducting of spirometry in the enrolled subjects via the diffusion of useful information for early detection of the symptoms of this disease with a simple questionnaire distributed by general practitioners, allows for identifying subjects suffering from COPD in the early stages of the disease. Among the subjects enrolled for spirometry based on four simple self-assessment questions concerning age, smoking habits and the presence of respiratory symptoms (cough, expectoration, dyspnea), it was possible to identify 757 patients suffering from COPD (64% out of the total number). Of particular significance was the observation that 71% of the patients identified with COPD had the disease in the early stages.

“Patients with COPD usually come under the observation of the specialist pulmonologist  at a much later stage, when healthcare intervention do not make it possible to achieve any appreciable results in the progression of the disease. It therefore seems evident that in the general population, the initial clinical assessment conducted by general practitioners, supported by the use of a simple questionnaire, is essential for diagnosing the disease in its less advanced stages, when important symptoms such as chronic cough and catarrh are often erroneously just attributed to exposure to smoking”, added Pistolesi.

While it is true that cigarette smoking represents the main cause of COPD, the other causes of the onset of this disease must not be overlooked given that 25-45 percent of people in the world with COPD are non-smokers.And in these cases, apart from the genetic factors, it is also important to consider other factors such as pollution, occupational exposure to dust or gases, and respiratory infections during childhood.

“Moreover, simple spirometry used in routine practice is not able to identify early structural changes in the lungs, while the functional reduction of the small airways of the lungs that precedes the onset of emphysema, can be detected with a micro CT scan of the chest” continued Pistolesi. “In these cases the micro CT scan of the chest allows for assessing the health conditions of the lungs and accurately diagnosing the presence of emphysema, that is, the thickening of the airways and consequent loss of elasticity of the lung tissue with the subsequent onset of this disease”.

Another field of study of COPD concerns the identification of the genetic causes of the disease. “The application of the genome-wide association studies (GWAS), which provide an unbiased, comprehensive research across the genome for common susceptibility loci, has changed the genetics landscape COPD. Thanks to the research based on GWAS, three genetic loci have been unequivocally associated with the COPD susceptibility, which is found on the chromosome 4 near the HHIP gene, on the chromosome 4 in the FAM13A gene, and on the chromosome 15 in a gene block containing various components of the acetylcholine and nicotine receptor. In the future, these studies may help in identifying subjects most at risk of COPD”, concluded Pistolesi. 


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