Diagnosing and treating COPD: understanding the challenges and finding solutions

Abstract

Chronic obstructive pulmonary disease (COPD) is characterized by airflow obstruction that is not fully reversible; symptoms include chronic cough, sputum production, and dyspnea with exertion. An estimated 50% of the 24 million adults in the USA who have COPD are thought to be misdiagnosed or undiagnosed. Factors contributing to this include a low awareness of COPD and the initial symptoms of the disease among the general population, acceptance of these symptoms as a consequence of aging or smoking, some symptomatic similarity to asthma, and failure of health care personnel to use spirometry for diagnosis. Increased familiarization with COPD diagnosis and treatment guidelines, and proactive identification of patients with increased risk of developing COPD through occupational, environmental, or lifestyle exposures, will assist in a timely, accurate diagnosis and effective treatment, which will consequently improve patient outcomes. This review addresses the issues surrounding the diagnosis and misdiagnosis of COPD, their consequences, and how COPD can be better managed within primary care, including consideration of COPD care in patient-centered medical home and chronic care models.

Keywords: chronic care model; misdiagnosed; patient-centered medical home; primary care; undiagnosed.

Figure 1

Disease course of chronic obstructive pulmonary disease. Notes: The decline in forced expiratory volume in 1 second (FEV₁) graph is adapted from Fletcher and Peto, 1977. Reproduced from “The natural history of chronic airflow obstruction,” British Medical Journal, C Fletcher, R Peto, Vol 1, 1645–1648, copyright 1977 with permission from BMJ Publishing Group Ltd. ^aRefers to an inhaled occupational/environmental toxin. Abbreviation: α1AHD, α1-antitrypsin deficiency.

Figure 2

Therapy at progressing stages of chronic obstructive pulmonary disease. Note: From the Global Strategy for Diagnosis, Management and Prevention of COPD, updated 2010 used with permission from the Global Initiative for Chronic Obstructive Lung Disease (GOLD), www.goldcopd.org. Abbreviations: FEV₁, forced expiratory volume in 1 second; FVC, forced vital capacity.

Figure 3

Chronic obstructive pulmonary disease care in a patient-centered medical home (PCMH). Abbreviations: COPD, chronic obstructive pulmonary disease; GOLD, Global Initiative for Chronic Obstructive Lung Disease; QoL, quality of life; PCMH, patient-centered medical home.