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Takeaways for Primary Care Physicians Treating COPD

may2019002Chronic obstructive pulmonary disease (COPD) is complicated and requires intensive and specialized treatment, more so than some may have previously thought. That’s according to University of Pittsburgh investigators who

Decreasing and withdrawing from inhaler use should also be conducted an analysis of the current literature to synthesize the discussion about the current diagnosis and treatments for COPD.

In their brief, the researchers wrote that 30 million adults in the U.S. have COPD, and most of these patients have been diagnosed by a primary care physician—despite the complicated and specialized nature of the disease.

The study, “Diagnosis and Outpatient Management of Chronic Obstructive Pulmonary Disease,” was published in JAMA. In it, investigators identified 90 applicable studies and, from those, 26 included clinical trials, 21 were meta-analyses, 25 were observational studies and 18 included guidelines and other reports.

The authors of the new study found that the primary risk factor for COPD diagnosis is tobacco smoke. They did note that other exposure to inhaled particles, such as indoor cooking or smoke from wood and other fuels, could also play a role.

Researchers noted that a patient’s misuse of inhaler devices for COPD pharmacotherapy is “both incredibly common and oftentimes unnoticed by healthcare providers.” Additionally, the authors believe that better screening for and correcting improper use of inhalers could lead to improved disease control and reduced care costs.

Craig Riley, MD, lead researcher of the review, told MD Magazine, “An inordinately large number of patients are either diagnosed presumptively without spirometry (and may not have COPD) or are diagnosed with other conditions (and may not have them) despite having exposures and symptoms consistent with possible COPD. Incorrect diagnoses lead to incorrect and ineffective treatments.”

Riley noted that people’s understanding of how inhaler devices work should allow providers to screen patients for proper use. Likewise, if a patient is unable to adequately draw medication into their lungs, they will not see a benefit and are at higher risk of clinical deterioration.

considered, especially in patients who are able to maintain stability of two years or longer without a moderate to severe exacerbation of symptoms.

Pulmonary rehabilitation has a greater comparative benefit on COPD symptoms, hospitalizations and death than pharmacotherapies, Riley said. He also noted that a majority of COPD patients are never made aware of these pulmonary rehabilitation programs, which are meant to combine strength and endurance training with educational, nutritional and psychosocial support. As well, the programs are designed to help patients improve cardiovascular fitness, physical activity levels and symptoms in COPD patients.

“Greater availability and utilization of pulmonary rehabilitation has the potential to improve quality of life, decrease hospitalization costs and has been suggested to improve mortality following hospitalization,” Riley said.

Click here to review all of the findings in MD Magazine.