A challenge to the seven widely believed concepts of COPD

Int J Chron Obstruct Pulmon Dis. 2013;8:21-30. doi: 10.2147/copd.s38714. Epub 2013 Jan 14.


This review proposes a critical reassessment (based entirely on published evidence) of the following seven common beliefs about chronic obstructive pulmonary disease (COPD): (1) COPD is one disease. (2) There is a valid definition for COPD. (The current definition includes cases of irreversible asthma and bronchiectasis, and occasionally, other obstructive lung conditions). (3) Irreversible asthma in smokers and COPD cannot be differentiated. (4) A "chronic bronchitis" form of COPD exists and is characterized by blue bloater status and normal carbon monoxide diffusion studies. (5) Phenotyping has no bearing on medication choice in COPD. (6) Computerized scoring of lung attenuation on CT scans can diagnose emphysema. (Emphysema scores overlap in irreversible asthma and COPD); however, qualitative visual changes may be useful for differentiation. (7) A definable entity called the overlap (of COPD and asthma) syndrome exists. Conflict over the above-mentioned points denies patients proper phenotype-guided therapy and encourages a multidrug approach to COPD management. The recently coined term, overlap syndrome, invites a double-barreled therapy aimed at asthma and COPD, despite the absence of any agreement about how to define the syndrome and the lack of any related drug trials (in the area of inhaled corticosteroids). A diagnosis of COPD is associated with high morbidity and escalating costs, suggesting the need for a thorough new examination of the evidence.

Keywords: COPD; asthma; computerized tomography; global initiative for chronic obstructive lung disease; overlap syndrome.

Publication types

  • Review

MeSH terms

  • Asthma / diagnosis
  • Asthma / physiopathology
  • Basement Membrane / pathology
  • Biopsy
  • Bronchi / pathology
  • Bronchiectasis / physiopathology
  • Bronchoscopy
  • Carbon Monoxide / metabolism
  • Diagnosis, Differential
  • Eosinophils / metabolism
  • Humans
  • Lung / diagnostic imaging
  • Neutrophils / metabolism
  • Phenotype
  • Pulmonary Diffusing Capacity / physiology
  • Pulmonary Disease, Chronic Obstructive / diagnosis*
  • Pulmonary Disease, Chronic Obstructive / physiopathology*
  • Pulmonary Emphysema / diagnostic imaging
  • Pulmonary Emphysema / physiopathology
  • Respiratory Function Tests
  • Sputum / cytology
  • Tomography, X-Ray Computed


  • Carbon Monoxide