It's estimated that about 12 million people in the United States have COPD, but there's probably another 12 million people who don't have a diagnosis, because they haven't undergone spirometry testing.
We know that one of the challenges related to diagnosing COPD is under-performance of spirometry testing.
The reality is that currently, most spirometry is performed within the pulmonary clinic. So this requires the patient to be recognized¬ – the potential to have COPD – the patient then to go to a pulmonary clinic and have the resources and insurance coverage to undergo spirometry testing, which can be expensive. There are several initiatives to move spirometry into the primary care setting, and I think that's probably one of the most important things that we can do to increase the diagnosis of COPD.
There's really very few impediments related to initiating spirometry testing in a primary care office.
First off, there are available resources for training. The spirometers are relatively inexpensive and they're portable. But more importantly, most electronic health records have a mechanism to identify a group of triggers that would prompt the primary care physician to perform testing.
For example, if an individual's over the age of 40, has a smoking history and may report some symptoms, that constellation of factors can then trigger the primary care provider to order spirometry testing. This basically takes the thinking out of the process, making it much easier for the primary care provider to conduct spirometry in their office.
So one of the questions is, well, what is the benefit to patients to perform spirometry in a primary care office. The reality is, it's actually easier for the patient. First off, they have a relationship with the primary care provider. So they probably are already used to going to that clinic. They probably haven't been seen by a pulmonologist, because they don't have a diagnosis of COPD.
Secondly, performance of spirometry is usually easier and more streamlined in a primary care office. And the pulmonary function testing clinics can often take more time and they require a separate visit.
Finally, the co-pays related to spirometry testing in a primary care office are often different from those in a full pulmonary function testing lab.
There's multiple motivations to initiate spirometry testing in a primary care office, both to increase the diagnosis, to better treat the patient and to potentially increase revenue within the clinic itself.
That's what our goal is. That's what good looks like.