Chronic obstructive pulmonary disease (COPD) is a preventable and treatable disease with significant extrapulmonary effects that can exacerbate the severity of the disease; COPD lungs are characterized by incompletely reversible airflow limitation that is progressively worse and is associated with an abnormal inflammatory response of the lungs to inhaled noxious particles or gases. COPD is an early biochemical and cellular level event, and once clinical and radiographic signs appear, the disease is already in an advanced stage, thus posing great difficulties for early diagnosis and early treatment of COPD; yet early intervention can maximize salvage of lung function, control respiratory symptoms, improve quality of life, and improve prognosis. Therefore, early diagnosis and early treatment are the focus of attention for COPD. I. Early diagnosis of COPD (a) Disease awareness Although the prevalence and mortality of COPD are high and have a tendency to increase significantly, causing a serious burden to society and individuals, the social awareness of COPD is seriously lacking. Due to the slow progression of COPD, many patients are not aware of their problems and attribute their shortness of breath to “aging” and consider their cough to be normal or “smoker’s cough”, ignoring COPD as the The “silent killer”. In China, the underdiagnosis of COPD is not only related to the slow progression of COPD and the lack of self-awareness of patients, but the inconsistent use of disease terminology also seriously affects the diagnosis of the disease. Although the term COPD has been proposed for a long time, 38% of physicians still do not use this terminology and 53% of patients use chronic bronchitis to describe their disease. Therefore, increasing the awareness of COPD in the whole society will help to improve the early diagnosis rate of COPD and make COPD truly preventable and treatable. (B) Pulmonary function tests Pulmonary function tests are still the gold standard for the diagnosis of COPD, but the problem is that they are not widely used at present. 1.Does the patient have frequent cough? 2.Is there frequent coughing of sputum? 3.Is the patient more prone to shortness of breath than people of the same age? 4.Are you over 40 years old? 5.Do you currently smoke or have you ever smoked? The current diagnostic criteria for obstructive pulmonary ventilation dysfunction is after inhalation of bronchodilators. It should be noted that there are some problems with using fixed ratios as diagnostic criteria: physiological lung volume decreases in the elderly, and fixed ratios lead to overdiagnosis of the elderly; in individuals <45 years of age, fixed ratios may lead to underdiagnosis. 7 as a diagnostic criterion. GOLD guidelines classify COPD as mild, moderate, severe and very severe according to the percentage of FEV1 to the expected value. This classification is simple and easy to use, but it does not reflect the systemic damage of COPD and correlates poorly with the patient's dyspnea and health status. There are many shortcomings of lung function as the gold standard for the diagnosis of COPD, and some alternative indicators of lung function need to be found. (iii) Other alternative indexes 1. HRCT of the chest A study showed that among people with respiratory symptoms but normal FEV1, HRCT examination showed that nearly 50% of them had emphysema, and the diffusion function measurement found that HRCT showed that the diffusion function of patients with emphysema was significantly reduced, which shows that HRCT is more sensitive to the early diagnosis of emphysema. In addition, HRCT is also a sensitive follow-up tool. A study showed that there was no significant difference in the annual decrease in lung function in the inhaled glucocorticoid (ICS) treatment group compared with the placebo group (54 ml in the ICS group and 56 ml in the placebo group, P=0,89), while HRCT showed a 0,4% decrease in the area of emphysema (<-910Hu) in the ICS group and a 1 increase in the placebo group. 2. Biomarkers Induced sputum is easy to manipulate, well tolerated that can reflect the local inflammatory process in the airways. However, the specimens mainly originate from the larger airways and do not reflect small airway inflammation, and the manipulation process of induced sputum itself can induce neutrophil inflammation; the sputum liquefaction procedure may interfere with the determination of cytokines and chemokines by exsanguination; the long-term reproducibility of induced sputum and its correlation with COPD severity and disease progression have also been questioned. Compared to induced sputum, exhaled breath is more readily available, reproducible and completely noninvasive. Of the exhaled breath NO, CO and volatile hydrocarbons, only ethane levels correlate with disease severity, but the measurement method is complex and not routinely applied. Exhaled gas condensates contain inflammatory factors such as oxidation products, leukotrienes, and cytokines, and condensate pH also reflects the degree of inflammatory damage to lung tissue. However, the large variability and extremely low concentrations of the indicators in the condensate increase the error of the assay and limit the clinical application. Plasma or serum bioindicators are also suggestive of COPD disease severity. Elevated baseline fibrinogen levels and surface active substance protein SP-D levels are indicative of an increased risk of acute exacerbation. 3. Symptom indicators Dyspnea is considered a reliable surrogate marker of COPD disease progression, and dyspnea correlates with physical activity and quality of life, while reflecting efficacy. Decreased exercise tolerance also worsens with disease progression. In addition, health-related quality of life (HRQoL) decline correlates well with acute exacerbations, FEV1 decline, treatment response and mortality. 4. The classic COPD questionnaire is the St. George's Respiratory Questionnaire (SGRQ), however, it is complex, tedious to count and time-consuming. The newly emerged COPD assessment test form contains only 8 questions, which is easy to understand, less time consuming, and has good correlation with SGRQ, and can be used to evaluate the severity of disease and follow-up. Early treatment of COPD The current treatment of COPD is mostly based on the graded treatment according to GOLD guidelines. Clinical practice confirms that this graded treatment scheme needs to be improved, and the reasonable forward movement of treatment measures may achieve better clinical efficacy. (i) Smoking cessation and vaccination Smoking is the most important risk factor for COPD, and smoking cessation is the most cost-effective intervention. Brief (3-minute) counseling of smokers by medical personnel can produce a 5% to 10% quit rate, and smoking cessation has a significant effect on delaying the 1% decline in FEV. Smokers who are willing to quit can be treated using the 5A method of asking, advising (advice), assessing (assess), helping (assist), and scheduling follow-up (arrange). Vaccination may reduce the number of acute exacerbations by reducing lung infections in COPD patients. Annual influenza vaccination is currently recommended for COPD patients. Pneumococcal vaccination is also recommended for COPD patients older than 65 years or younger than 65 years but with FEV1 < 40% of the expected value. (ii) Inhaled hormones Studies have found that inhaled hormones (ICS) combined with long-acting bronchodilators (LABA) can significantly reduce all types of local inflammatory cell infiltrates, mast cells in the airways. Clinical studies have also shown the advantages of early use of ICS+LABA. the TORCH study included nearly 40% of patients with moderate COPD and showed that ICS+LABA reduced acute exacerbations, slowed the rate of decline in lung function, and improved quality of life in patients with all degrees of COPD; it was more effective in reducing all-cause mortality and acute exacerbations of COPD in patients with moderate COPD. Therefore, appropriately shifting the indications of ICS+LABA can achieve better clinical efficacy and delay COPD disease progression. (iii) Long-term home oxygen therapy Studies in the 1980s showed that long-term oxygen therapy could improve the survival rate of patients with COPD with chronic respiratory failure, and therefore the LTOT indication was developed for severe hypoxemia. However, many questions remain in clinical practice: LTOT in patients with mild to moderate hypoxemic COPD, LTOT in patients with hypoxia during exercise and sleep, and benefits beyond LTOT survival such as health-related quality of life, exercise capacity, etc.