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Preclinical vascular disease identifies smokers at risk for COPD

Chronic obstructive pulmonary disease (COPD) is the only disease among the 10 leading causes of death in the United States with a prevalence that has steadily increased over the past four decades and for which no effective therapy has been developed to substantially blunt its progressive course. COPD has climbed to become the fourth leading cause of death in the United States, leading to the deaths of more than 120,000 people each year. Healthcare expenses and loss of work because of this disease have been estimated to cost over $37 billion annually. COPD is traditionally identified by the finding of an irreversible chronic airflow limitation. This limitation is thought to be present (diagnosed and undiagnosed) in up to 50 million people in the United States (1). Smoking has been clearly identified as the primary cause for COPD, but to date, there is no effective means to identify this disease before it becomes clinically manifested as airflow obstruction and impairs function or quality of life. The report by Alford et al. (2) in PNAS describes the use of ECG-gated multidetector row computed tomography (CT) perfusion imaging to identify vascular dysfunction in smokers with normal lung function and correlates this information with very early CT manifestations of centrilobular emphysema. This suggests a minimally invasive image-based biomarker that can identify subjects at high risk for developing COPD. Hopefully, this biomarker will stimulate new fields of research that could result in the development of preventative therapies for this poorly controlled disease epidemic.