COPD insider

Identifying COPD patients:

The first step to quality outcomes

Learn how to identify patients with chronic obstructive pulmonary disease (COPD) sooner by proactively focusing on additional risk factors, special populations, and more.

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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.

According to the Centers for Disease Control (CDC):

COPD-related healthcare costs
in 2010 were = $36 billion

Costs are projected to increase 
to $49 billion by 2020

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.

Contributors

Les Duncan

Director of Operations, Highmark - Community and Health Services

Brian Carlin, MD, FCCP, FAARC

Pulmonary and Critical Care Physician,
Altoona Regional Health System

Christina Cunningham, RRT

Director of Clinical Services, CHI Health at Home

Jennifer Anderson, MBA, RRT, AE-C

Director Respiratory Care and Pulmonary Function Labs,
AU Medical Center

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.

On focusing on the breadth

—Les Duncan, Director of Operations

Highmark–Community and Health Services

Early intervention - more important than ever

 

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.

Learn to see through the smoke

 

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.

When it comes to the literal smoke, the data is clear:

of COPD cases are
smoking-related3

are due to occupational exposures to smoke,
fumes or other toxins3

are due to genetic factors2

The figurative smoke is harder to see. It requires us to see the reality that:

 

Patients often fail to report COPD symptoms

 

  • Shortness of breath : patients may think dyspnea a
    natural consequence of aging or weight gain -not smoking- and
    never bring it up

  • Chronic cough : patients may grow so accustomed to coughing
    it becomes their normal - they don't even think it's
    worth mentioning

Insider intel

COPD is often missed because attention is focused on other chronic smoking-related conditions

-Heart failure
-Asthma
-Cancer
-Osteoporosis
-Diabetes

Rely on risk factors in addition to 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.

Additional risk factors include :

 

-  Multiple recurrent infections

-  Childhood respiratory tract infections

-  Tuberculosis

-  Malnutrition

-  Low birth weight or premature birth

-  Bronchopulmonary dysplasia

-  Poverty

-  Low health literacy

On reading the
risk factors

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.

Keep special populations in your sights

Certain patient populations are more prone to present with COPD than we might expect. For example, HCPs should consider paying particular attention to:

Women

For years, COPD was considered a “man’s disease.” But cultural changes over the decades shifted the demographics of smoking, and today more women die from COPD than men.

Depression

People with chronic depression are often heavy smokers. In fact, some data suggest a linear relationship between the number of packs smoked a day and the severity of one’s depression.

Schizophrenia

Nicotine can have a calming effect on patients with schizophrenia. There are a high percentage of multiple-pack-a-day smokers in this population.

 

Addressing the needs of patients with COPD and concurrent psychiatric pathologies requires a sensitive multidisciplinary effort. This can help us treat the root causes of those pathologies. And we need to appreciate and address the gender bias that continues to skew diagnoses toward asthma instead of COPD, as we work to improve the care of women patients.

What we take in, we put back out

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.

On giving COPD its fair share

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

On the importance of COPD certification

—Jennifer Anderson, MBA, RRT, AE-C,
Director Respiratory Care and Pulmonary
Function Labs

AU Medical Center

On a whole patient approach

—Christine Cunningham, RRT,
Director of Clinical Services

CHI Health at Home

Tools of the proactive trade

 

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.

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