Primary care of the patient with chronic obstructive pulmonary disease-part 1: frontline prevention and early diagnosis

Abstract

Chronic obstructive pulmonary disease (COPD) is the most important chronic respiratory illness affecting adults in the United States, yet it remains grossly underdiagnosed. This article translates key guideline recommendations for prevention and early diagnosis of COPD into the practical context of primary care. A literature review identified clinical trials with relevant information on COPD epidemiology, diagnosis, the role of primary care clinicians, the implementation of spirometry, and the impact of smoking cessation. After formal presentations to a panel of pulmonary specialists and primary care clinicians, key messages were identified and integrated to create this first report in a 4-part mini-symposium. The main points of the roundtable consensus were as follows: (1) > or =50% of smokers will develop some degree of COPD; (2) patients with earlier stages of COPD are often undiagnosed; (3) too many clinicians are not aware that COPD is partially reversible; (4) treatment of COPD can improve patient symptoms, exercise capacity, quality of life, and health status, and prevent exacerbations; (5) diagnosis can be easily accomplished with a careful history and in-office spirometry in symptomatic patients and those at risk (e.g., present and past smokers); and (6) all smokers should be identified and targeted for smoking cessation programs. We conclude that primary care clinicians see the vast majority of patients with early or mild COPD. These practitioners must become aware that COPD is an important problem in their patient population and that they need to integrate simple questions and in-office tools into their practice to increase their diagnosis of COPD.