Identifying COPD patients:
The first step to quality outcomes
There are at least 12 million reasons to improve the management of COPD in the United States today.
Each of those reasons has a name. A history. An occupation. Friends, family, and loved ones who care about them.
Each is an American living with COPD, one of approximately 24 million overall. But these 12 million1 are unaware of their condition. They’re undiagnosed, even though they may be under our care for other reasons. Their disease is progressing unchecked, and it’s costing us.
COPD is the third leading cause
of death in the United States
-There were 137,000 COPD-related deaths in 2010
These numbers are staggering. The challenge to improve the situation demands that we actively pursue early diagnosis of COPD. This will pave the way to improving quality outcomes and reducing healthcare costs.
The good news is we can begin doing so today. In this article, our experts at COPD insider show you how. They share insights that will help you identify COPD patients early—before their condition, its costs, and the quality of their lives spiral out of control.
Regrettably, many of those 12 million people will first be diagnosed with COPD upon index admission to a hospital following a clinical exacerbation. This is regrettable because early diagnosis and intervention before hospitalization can lead to better management of COPD.
It's also critical to get in front of the problem because reducing hospital admissions is a metric for success in population health. It can result in significant revenue for private and institutions under initiatives such as the Center for Medicare & Medicaid Services (CMS) Shared Savings Program.
So how do we get in front of the problem? In part by adopting a longitudinal, proactive approach to care instead of an episodic, reactive one.
This requires us to do a little more, dig a little deeper.
To not just look past the literal smoke, but the figurative smoke that screens so many COPD patients from our view.
Patients often fail to report COPD symptoms
Failure to report symptoms means we can’t rely on those symptoms alone to make a COPD diagnosis. And the tangle of chronic comorbidities makes it that much harder to pinpoint COPD in the mix.
For these reasons, our experts recommend keeping an eye out for a host of other important risk factors. Along with smoking, these help paint a clearer picture of the whole patient and can identify those most at risk for COPD.
- Multiple recurrent infections
- Childhood respiratory tract infections
- Tuberculosis
- Malnutrition
- Low birth weight or premature birth
- Bronchopulmonary dysplasia
- Poverty
- Low health literacy
Jill Ohar, MD, FCCP
Professor of Internal Medicine, Pulmonary,
Critical Care, Allergy, and Immunological Diseases,
Wake Forest University School of Medicine;
Director of Clinical Operations,
Wake Forest University Baptist Medical Center.
Nicotine can have a calming effect on patients with schizophrenia. There are a high percentage of multiple-pack-a-day smokers in this population.
Who is this “we” we keep talking about? It’s all of us, every single stakeholder in the COPD arena: the entire respiratory care team, patients with COPD, their caregivers, and American society as a whole.
Collectively, we need to do a better job of raising awareness about COPD. The effort we put in to education and training will be reflected in what we put out, in terms of identifying and managing COPD more skillfully.
It begins with the care team: physicians, pulmonologists, nurses, respiratory therapists (RTs), COPD coordinators, discharge planners, and more. Our experts at COPD insider agree that the medical community as a whole needs to improve training programs in COPD nationwide. The more training a care team has, the more likely they are to identify patients with COPD early.
Consideration should also be given to helping staff become certified COPD educators. Doing so raises awareness even among those we might consider at the top of their game already, such as RTs. Through certification, RTs can learn techniques like motivational interviewing (counseling patients in a way designed to facilitate behavior change). This can enhance their ability to effectively probe for symptoms of COPD and educate patients about the importance of acknowledging what they're experiencing.
A couple of years ago, I was a trainee program director. In many centers around the country - Ohio State, NYU, UC Davis - the average COPD training time for residents was 1 hour per year. They spent more time on dermatology lectures than they did on COPD.''
- Brian Carlin, MD, FCCP, FAARC Pulmonary and Critical Care Physician
Altoona Regional Health System
—Jennifer Anderson, MBA, RRT, AE-C,
Director Respiratory Care and Pulmonary
Function Labs
AU Medical Center
—Christine Cunningham, RRT,
Director of Clinical Services
CHI Health at Home
Spirometry remains the #1 way to diagnose COPD. When you see risk factors like the ones detailed above—when motivational interviewing techniques reveal hidden patient symptoms—or whatever else leads you to suspect COPD, spirometry should be your go-to test.
And yet, spirometry remains woefully underutilized in COPD today. There are many reasons for this, and we’ll explore them—as well as potential solutions—in a future COPD insider article.
For now, suffice it to say that spirometry is key to accurately diagnosing COPD. And it is one of many keys that should be used as part of an encompassing, whole-patient approach to assessing risk.
When you look for COPD, know what you are looking forward to: helping 12 million undiagnosed Americans find quality care for a better quality of life.
1: NIH: Report - Fact Sheets, COPD 2013
2: WVHealth Statistics Center, Chronic Lower Respiratory Disease, 2006
3: Centers for Disease Control and Prevention, Public Health Strategic Framework for COPD Prevention, Atlanta, GA: Centers for Disease Control and Prevention; 2011.
