Enhancing COPD Management in Primary Care Settings

Jill A. Foster, MD, MPH; Barbara P. Yawn, MD, MS, MSc, FAAFP; Maziar Abdolrasulnia, PhD; Todd Jenkins, MPH; Stephen I. Rennard, MD, FCCP; Linda Casebeer, PhDs

Disclosures
In This Article

Introduction

Chronic obstructive pulmonary disease (COPD) is the fourth leading cause of death and affects more than 1 in 20 adults in the United States.[1,2] Smoking is the most important cause but other factors may also be significant.[3,4] Despite its high prevalence, only a fraction of individuals with COPD have been diagnosed.[5,6] The slow progression of COPD and its early symptoms are often unrecognized by both patients and physicians despite substantial deterioration in health status and increased risk of mortality.[7] As a result, the initial diagnosis often occurs at an advanced disease stage.[8]

In 2001, the Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Diseases (GOLD)[9] was published, marking a new generation of evidence-based guidelines. Jointly developed by the National Heart, Lung, and Blood Institute (NHLBI) and the World Health Organization (WHO), the guideline was designed to be a core resource for primary care physicians, who care for the majority of patients with COPD.

In response to findings suggesting underdiagnosis and underutilization of spirometry for detection and diagnosis, a series of campaigns to increase primary care physician awareness of COPD and best clinical practices have been conducted.[10] Despite these efforts, many primary care physicians are unaware of COPD guidelines[11] and the diagnosis of COPD on the basis of clinical findings alone remains common practice, leading to misdiagnosis, undertreatment, and inappropriate management.[12,13,14,15,16]

Interventions designed to enhance availability and comfort with spirometry in primary care settings have had variable long-term success[17,18,19] and have not been implemented broadly. This suggests that more effective approaches may be needed to effectively improve recognition and management of COPD. The present study was designed to further examine COPD from a primary care perspective. The study sought to examine the outpatient clinical choices of primary care physicians relative to guideline-based recommendations. Physicians' perceptions about COPD as well as their learning preferences were also assessed. Findings from this study are expected to provide an educational framework for creating more effective COPD programs.

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