The head of Pulmonology at the Virgen de la Victoria University Hospital, José Luis Velasco, warns that in Spain, the underdiagnosis of COPD is around 70%. The specialist calls for early detection and warns of the lung damage caused by vaping.
The 70% of cases of chronic obstructive pulmonary disease (COPD) in Spain are undiagnosed. This is stated by the head of the Pulmonology Department at the Virgen de la Victoria University Hospital, José Luis Velasco, who places the underdiagnosis at figures close to that proportion based on epidemiological studies published in the country, as reported by Diario Sur in the context of World Lung Day, celebrated on September 25.
The specialist explains that the problem is detected daily in consultations: the patient begins to limit themselves, continues to feel breathless, but since they no longer engage in that activity, they no longer feel breathless. "They limit themselves, but the disease is not diagnosed," notes Velasco, who adds that often the symptoms are attributed to shortness of breath, cough, fatigue, age, overweight, or the smoking habit itself.
COPD persistently hinders airflow through the lungs and is related to tobacco consumption in over 90% of cases. Its most common symptoms include shortness of breath during exertion, chronic cough, sputum production, a feeling of suffocation, wheezing when breathing, and fatigue. The patient gradually reduces their activity to avoid dyspnea, which contributes to the disease going unnoticed and being diagnosed late.
"Since the patient enjoys smoking, what they don't want to hear is that they must quit smoking. So, they arrive late," reflects the doctor.
Velasco insists that when the diagnosis comes late, the margin for action is reduced: "When you arrive late to a disease, what you need are good respiratory therapies, but there is already damage that is irreversible." The main respiratory risk factor remains tobacco, which increases the likelihood of various types of cancer, including lung, laryngeal, and stomach cancer, and is also associated with sudden death. "There is no lower limit that exempts you from being a risk factor," he warns.
The pulmonologist observes an increase in lung cancer among women, a phenomenon he attributes to the later adoption of smoking habits by women compared to men. Regarding vaping, he expresses concern because, in his opinion, a message is being conveyed that it is harmless when the World Health Organization states otherwise. "I am worried about vaping because a message is being given that it is harmless, when the World Health Organization is clear that it is not," he states. He recalls that there are already data on lung damage and respiratory functional alterations, and that many young people start vaping at 12 or 13 years old, although the associated respiratory disease will not be seen until 20 or 30 years of exposure.
In addition to COPD, Velasco mentions other underdiagnosed conditions, such as diffuse interstitial lung diseases or pulmonary fibrosis, which present an insidious clinical picture of dry cough and exertional dyspnea that already implies irreversible scarring in the lungs. The specialist advocates for the need to advance in early detection programs for lung cancer, similar to those that exist for breast or colon cancer, and emphasizes that there are already studies to determine whether such screening is cost-effective.
Regarding treatments, he highlights that personalised medicine has also reached respiratory diseases, with biological therapies for asthma and drugs such as mepolizumab and dupilumab for COPD. On other risk factors, he points out that, in addition to tobacco, second-hand smoke, occupational exposures such as asbestos, and excessive air pollution play a role, not forgetting genetic and biological factors. Obesity, for its part, affects sleep apnea and alters the patient's quality of life.
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