"If You Have Shortness of Breath Even Without Smoking, Suspect COPD"... Developing Korean-Specific Diagnostic Criteria

Various Causes of Chronic Obstructive Pulmonary Disease, Including Tuberculosis and Fine Dust
Pulmonary Function Tests Introduced in National Screenings... Early Diagnosis at Ages 56 and 66

The pattern of chronic obstructive pulmonary disease (COPD), which is commonly believed to affect only smokers, is changing. One out of every three COPD patients in Korea has never smoked, and risk factors now include a history of infectious diseases such as tuberculosis, asthma, impaired lung development, and air pollution from fine dust and other sources. With pulmonary function testing introduced into the national health screening program this year, experts are calling for new diagnostic and treatment guidelines tailored to the characteristics of the Korean population.

On June 16 at Konkuk University Medical Center in Gwangjin-gu, Seoul, Kwangha Yoo, Director of Konkuk University Medical Center (Chairman of the Korean Academy of Tuberculosis and Respiratory Diseases), stated to the press, "COPD can only be diagnosed through testing," adding, "While prevention and treatment are possible, it cannot be completely cured, and the low level of awareness is a significant problem."

COPD is a chronic respiratory disease in which harmful gases cause inflammation and destruction of lung parenchyma, leading to a persistent decline in airflow. Its main symptoms are shortness of breath, chronic cough, and sputum production. However, in the early stages, people often attribute breathlessness to aging or decreased physical fitness and overlook it. Director Yoo explained, "Most people come to the hospital when they find themselves out of breath going up a slight incline or unable to keep up while hiking."

Director Kwangha Yoo of Konkuk University Hospital (Chairman of the Korean Academy of Tuberculosis and Respiratory Diseases) is speaking to the press on the 16th at Konkuk University Hospital in Gwangjin-gu, Seoul. Korea Disease Control and Prevention Agency

The prevalence of COPD among people aged 40 and over in Korea is 12.9%, with an estimated 3 million patients. Among those aged 65 and over, the prevalence exceeds 20%. The socioeconomic cost of COPD is estimated at about 1.4 trillion won per year. However, the diagnosis rate among people aged 40 and over is only 2.3%, and the treatment rate is just 1.2%. In reality, out of every 1,000 patients, only about 23 are aware that they have the disease.

The reason COPD often goes undetected is because its early symptoms are not pronounced. Many people attribute shortness of breath to normal aging, or non-smokers may believe COPD is unrelated to them, which delays their visit to a hospital. Jin Guk Lee, Professor of Respiratory and Allergy Medicine at Konkuk University Medical Center, explained, "Survey data shows that 30% of patients in Korea have never smoked in their lives. Other risk factors include issues related to birth and growth, histories of infections such as tuberculosis and pertussis, outdoor air pollution as well as indoor air pollution from heating and cooking, occupational exposure, and long-term uncontrolled asthma."

In particular, the importance of COPD management is growing in Korea, where the past burden of tuberculosis was high and, more recently, air pollution and population aging are converging. This is why experts argue that, rather than screening patients based solely on smoking status, a diagnostic and treatment system that reflects the causes and patterns of the disease among Korean patients is necessary.

Professor Moon Jiyong of the Department of Pulmonology and Allergy at Konkuk University Medical Center is explaining pulmonary function tests at Konkuk University Medical Center in Gwangjin-gu, Seoul, on the 16th. Photo by Korea Disease Control and Prevention Agency

In response, the government is working on developing diagnostic criteria by COPD subtype and customized treatment technologies for Koreans. International guidelines classify COPD into five subtypes: hereditary, originating from abnormal lung development, post-infection, smoking-related, and asthma-related. Youngyeol Kim, Head of the Division of Respiratory and Allergic Diseases at the National Institute of Health of the Korea Disease Control and Prevention Agency, said, "Seventy-one percent of COPD patients in Korea have two or more causes," adding, "Disease patterns, age of onset, gender ratio, and fatality rates vary depending on the risk factors, so precision management and treatment by subtype are essential."

From this year, pulmonary function tests have been introduced for individuals aged 56 and 66 as part of the national health screening program. Those with abnormal findings during screening will undergo further testing to determine whether they have COPD. Kim stated, "We expect that a significant number of those screened will be asymptomatic or in the early stages of the disease as potential patients,” and added, “We anticipate that approximately 100,000 to 150,000 people will be found to have abnormal findings."

For COPD, after an abnormality is detected in a spirometry test during a health checkup, a definitive diagnosis is made through a detailed pulmonary function test following the administration of a bronchodilator. If the ratio of forced expiratory volume in one second (FEV1) to forced vital capacity (FVC) is below a certain threshold in the spirometry, a more detailed test is necessary. Professor Ji-yong Moon of the Department of Respiratory and Allergy Medicine at Konkuk University Medical Center explained, "The process for confirming COPD is to do a spirometry test during a health screening, and if a problem is found, visit a hospital to undergo spirometry again after bronchodilator administration for a definitive diagnosis."

Demonstration of lung function testing. Photo by Korea Disease Control and Prevention Agency

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