MeiLan K. Han, MD, MS

Panelists discuss how dysbiosis of the lung microbiome can exacerbate chronic obstructive pulmonary disease (COPD) through increased inflammation and altered immune responses. In contrast, chest CT imaging is indicated for patients with severe COPD, suspected comorbidities, surgical planning, or unexplained symptoms despite standard treatment. These factors highlight the complexity of COPD management.

Panelists discuss the initial thought that postbronchodilator spirometry would help differentiate chronic obstructive pulmonary disease (COPD) from asthma. However, postbronchodilator spirometry adds time and effort, as well as exposing a patient to short-term medication that may have adverse effects. Guidelines favor a fixed ratio of forced expiratory volume in the first second to forced vital capacity (FEV1/FVC; < 0.7) because of the ratio’s simplicity and is independent of other reference values.

Panelists discuss how chronic obstructive pulmonary disease (COPD) management follows a stepwise approach, beginning with bronchodilators (typically short-acting β2-agonists/long-acting β2-agonists) and progressing to combination therapy with long-acting muscarinic antagonists/inhaled corticosteroids based on symptom severity. Current unmet needs include more targeted anti-inflammatory treatments, better biomarkers for phenotyping, and therapies to halt disease progression, particularly for those who don’t respond well to conventional treatments.

Panelists discuss how, despite being preventable and treatable, chronic obstructive pulmonary disease (COPD) has emerged as a major global health challenge due to widespread exposure to risk factors, particularly tobacco smoke, which remains the primary cause despite declining smoking rates in some regions. Early environmental exposures play a crucial role—workplace pollutants, air pollution, and secondhand smoke can damage developing lungs, whereas genetic factors like α1-antitrypsin deficiency increase susceptibility.

Panelists discuss current statistics indicating that COPD is one of the top three leading causes of death worldwide, with high morbidity and mortality rates, particularly in individuals over 40 years of age, and a growing global burden due to risk factors like smoking and air pollution.

Panelists discuss major risk factors for COPD development, including smoking, long-term exposure to environmental pollutants, and genetics, while noting that a history of asthma, early bronchitis, respiratory infections, and sex (with higher prevalence in men) may also influence disease onset and progression.

Panelists discuss COPD as a chronic inflammatory lung disease characterized by persistent airflow limitation, typically diagnosed through spirometry, and highlight common respiratory symptoms including chronic cough, sputum production, and dyspnea.