Chronic Obstructive Pulmonary Disease (COPD): Why We Need Better Patient Identification for 21st-Century Treatments

Chronic Obstructive Pulmonary Disease: Why We Need Better Patient Identification for 21st-Century Treatments

January 28, 2026

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By Léon Van Wouwe, Clinical Innovation Director, Volv Global

Introduction: COPD as a “Syndrome,” Not Just One Disease

Chronic Obstructive Pulmonary Disease (COPD) is often described as “smoker’s lung,” but modern guidelines now define it as a heterogeneous lung condition caused by damage to the airways and/or air sacs (emphysema) from different risk factors, including smoking, air pollution, early-life insults, and genetic causes such as alpha-1 antitrypsin deficiency (AATD). [1,2] (“early-life insults” refers to harmful exposures or adverse events in early life that impair lung development and increase later COPD risk.)

Worldwide, it is estimated that COPD affects hundreds of millions of people and is among the leading causes of death and disability.[1,3] As AstraZeneca notes on its respiratory disease pages, COPD and asthma “profoundly affect the lives of millions” and place a heavy burden on health systems, with many deaths considered potentially preventable through better care and management. [4]

And yet, COPD remains under-recognised and under-diagnosed. Many people with persistent cough, breathlessness, or frequent “chest infections” never undergo spirometry (a non‑invasive breathing test that measures how much and how quickly air moves in and out of your lungs), or receive a formal diagnosis until their disease is already advanced. [3,5–7] Typical patterns include:

Symptom onset in mid-life (40s–50s) with slowly increasing cough and breathlessness
Diagnosis delayed for years, often only after a serious exacerbation or hospital admission [5–7]
Symptoms misattributed to ageing, being unfit, asthma, or recurrent bronchitis

Within the broad COPD label, there are specific, treatable forms. AATD is the most common genetic factor linked to COPD; with around 90% of affected individuals thought to remain undiagnosed. [8–10] In severe forms, AATD causes emphysema and COPD, sometimes in non-smokers or at younger ages, yet these patients may be managed as “typical” COPD patients unless specific tests are done.[8–10]

For a syndromic condition like COPD, the core theme of this article series is especially clear:

To fully benefit from today’s and tomorrow’s treatments, we must improve who we identify, how early we identify them, and how well we understand their likely disease course.

The Typical Patient Journey – and Where We Lose People

The “average” COPD journey often looks like this:

Early symptoms – easy to overlook
A person notices a persistent cough, mild breathlessness on stairs, or morning “smoker’s cough.” Symptoms start gradually, so many people explain them away as “getting older,” being out of shape, or having mild asthma or repeated infections. [6,7] They may not seek specialist care, and lung function tests are often not performed in primary care. [5,6]
Worsening over time – still under the radar
Respiratory symptoms slowly get worse. People cut back on physical activity, rely on more antibiotics or steroid tablets for “chest infections,” or avoid activities that trigger coughing. For patients with AATD-related COPD, this deterioration can begin much earlier (for example, in their 30s or 40s), and because they may not be heavy smokers, clinicians may be less likely to suspect COPD or a genetic cause. [8–10]
First major exacerbation or hospitalisation – the diagnostic “shock”
A severe flare-up (exacerbation) or hospital admission often becomes the turning point when spirometry and imaging are finally done and a diagnosis of COPD is made. [6,7] By that time, significant lung damage may already have accumulated.
Chronic disease with very different trajectories
After diagnosis, some patients remain relatively stable for years, while others experience rapid lung function decline, repeated exacerbations, and early mortality. The Global Initiative for Chronic Obstructive Lung Disease (GOLD) and other sources emphasise this variability and the need to understand different disease pathways rather than treating COPD as a single entity. [1,2]

This journey underlines why timing and precision matter:

We need earlier diagnosis, before the first catastrophic exacerbation.
We need to distinguish which kind of COPD a person has, including if there are genetic causes like AATD.
We need outcome prediction to see who is likely to worsen quickly and who will benefit most from more intensive therapy.

Why a “One-Size-Fits-All” Approach No Longer Works

Over the past decade, treatments for COPD have advanced significantly. Companies like AstraZeneca and GSK – as key examples – have developed once- or twice-daily maintenance inhalers, including single-device triple therapies, to improve lung function, control symptoms, and reduce exacerbations.

AstraZeneca’s Breztri Aerosphere is a fixed-dose triple combination of an inhaled corticosteroid, a long-acting muscarinic antagonist, and a long-acting β₂-agonist, indicated for the long-term maintenance treatment of COPD, including chronic bronchitis and emphysema, and to help reduce flare-ups in patients who remain symptomatic on dual therapy. [11–13] AstraZeneca’s phase III THARROS trial is evaluating whether Breztri can also improve cardiopulmonary outcomes in higher-risk COPD populations. [3]
GSK’s Trelegy Ellipta (fluticasone furoate/umeclidinium/vilanterol) is a once-daily triple inhaler approved for the long-term maintenance treatment of airflow obstruction in COPD and to reduce exacerbations in patients with a history of flare-ups. [14,15] GSK’s Ellipta portfolio and device design aim to provide a simple, consistent inhaler platform for patients and clinicians. [16] GSK also provides patient-facing Trelegy resources focused on practical inhaler use and getting the most from daily treatment. [17]

Both companies offer online resources for healthcare professionals and patients that reinforce key messages:

COPD is a long-term, progressive condition with significant impact on daily life and health-system burden. [4,16]
Long-term maintenance therapy aims to improve day-to-day symptoms and reduce exacerbations, rather than treat sudden breathing attacks. [11,14,15,17]
Getting the inhaler technique right and using the medicine regularly are essential, which is why both Breztri and Trelegy platforms provide step-by-step inhaler guidance and patient support tools. [13,17]

However, simply giving more people triple therapy does not automatically translate into better outcomes. COPD is extremely heterogeneous:

Some patients are frequent exacerbators; others rarely flare.
Some have eosinophilic or Type-2 inflammation, making them good candidates for certain future biologics.
Some have emphysema-dominant disease due to AATD or other causes, where additional disease-specific strategies may be needed. [2,8–10]

If we treat all COPD patients the same way, we risk under-treating those at highest risk and over-treating those who might do well with simpler regimens. We also miss the chance to identify patients whose COPD is actually the outward expression of another, specific and treatable condition like AATD.

How Better Identification and Prediction Could Change COPD Care

A more modern, prediction-driven model of COPD care would align diagnostic innovation with therapeutic innovation from companies like AstraZeneca and GSK.

Active case-finding instead of waiting for crises
Rather than diagnosing COPD only after a major flare-up, primary care teams could use simple questionnaires, smoking history, repeated respiratory prescriptions, and electronic health-record flags to identify people at risk and prompt earlier spirometry. [6,7,15]
Routine testing for underlying causes, especially AATD
For all adults with persistent airflow obstruction, guidelines and expert bodies now stress the importance of testing for AATD. [8–10] The COPD Foundation notes that around 90% of people with AATD-related COPD are currently undiagnosed, yet early diagnosis can slow disease progression and improve quality of life. [8] The National Heart, Lung, and Blood Institute (NHLBI) highlights that a simple blood test can identify AATD and open the door to tailored management. [9]
Moving from “COPD yes/no” to “which COPD is this?”
Using a combination of spirometry, imaging, blood markers (e.g. eosinophils), and clinical history, clinicians can classify patients into treatable traits groupings:
- Frequent exacerbators.
- Eosinophilic / Type-2 inflammation phenotypes.
- Emphysema-dominant or AATD-related disease.
- Pollution- or biomass-related COPD (This mirrors how GSK’s medical COPD resources increasingly focus on disease stability, patient experience, and even machine-learning approaches to predict exacerbations using real-world data.) [16]
Outcome prediction to guide therapy decisions and timing
Predictive models – including those showcased in company-sponsored education and at respiratory congresses – are beginning to estimate an individual’s risk of future exacerbations, lung-function decline, and hospitalisation. [15,16] These tools could:
- Identify patients who should step up from dual to triple therapy with Breztri or Trelegy, earlier.
- Flag those who might benefit from intensified monitoring or future targeted biologics.
- Highlight patients with patterns suggestive of AATD-related COPD, prompting genetic testing and specialist referral.
Linking omnichannel education to real-world care
Pharma companies working in the field, such as AstraZeneca and GSK, already host rich COPD content for both healthcare providers and patients – from disease overviews to inhaler videos and downloadable tools. [4,13,16,17] An ideal future ecosystem would link predictive algorithms and electronic alerts directly to these resources.
- A patient flagged as high-risk after an exacerbation could receive a personalised digital pathway that points them to Breztri or Trelegy inhaler education, pulmonary rehabilitation, and lifestyle support.
- A clinician seeing a primary-care prompt for an undiagnosed at-risk patient could be guided to GOLD-aligned diagnostic steps and AATD testing information, plus brief materials from AstraZeneca and GSK explaining treatment goals and inhaler options. [1,2,4,11,14,16]

Conclusion: A New Era for COPD – If We Recognise It

COPD is not a single disease, but a syndrome with many faces. As GOLD, WHO, and leading companies all emphasise, it causes a huge burden of avoidable illness and death worldwide, yet often remains hidden for years. [1,3,4]

The leading pharmaceutical companies in the area, AstraZeneca and GSK, have helped transform the COPD treatment landscape with advanced maintenance inhalers like Breztri Aerosphere and Trelegy Ellipta, and they provide extensive online tools to help both clinicians and patients use these therapies effectively. [11–17] But these innovations will only reach their full potential if they are matched by equally modern approaches to identification and risk prediction.

That means:

Catching COPD earlier through active case-finding.
Looking beyond the simple diagnosis to understand which subtype or treatable trait a patient has.
Using prediction models to guide when and how to escalate treatment.
Systematically screening for genetic causes like AATD when COPD is diagnosed.

Only by bringing together better diagnosis, richer prediction, and targeted treatments can we ensure that the right COPD patient receives the right intervention at the right time – and that the impressive science now visible on AstraZeneca and GSK’s web pages translates into real-world lives improved and saved.

Reflective Questions

Where in the COPD patient journey – early symptom reporting, repeated “chest infections,” first exacerbation, or post-hospital follow-up – could predictive tools linked to resources from AstraZeneca and GSK make the biggest difference in identifying high-risk patients?
What are the main obstacles (awareness, reimbursement, digital infrastructure, time in consultations) to making AATD testing, trait-based assessment, and outcome prediction part of everyday COPD care, and how could industry and health systems work together to overcome them?

About the author

Léon van Wouwe has 20+ years’ global experience in clinical development and operations, uniting data science with pharma and research. He drives cross-functional collaboration to advance innovative treatments.