COPD: Screening, Diagnosis and Treatment
Assessment of Current Standards
Abstract
Are the current treatment standards for
emphysema and chronic bronchitis effective for
reducing symptoms, preserving function and for
reducing hospitalizations from periods of
exacerbation?
Purpose
The purpose of this research is to determine if the
current standards for COPD treatment are
sufficient, or if changing or adding to the
standards ought to be considered to improve
patient outcomes.
Current Standards for COPD Screening and Diagnosis
- The current diagnostic standard for COPD is
1
post-bronchodilator spirometry testing .
- Additional testing includes chest X-ray and CT scan
- The USPSTF recommends against screening
asymptomatic adults 2 asymptomatic adults. According to the
David M Johnson, PA-S Rocky Mountain University of Health Professions
COPD: Current Standard of Treatment A case for “Case Finding”
- The goal of COPD management is to prevent The opportunity for early diagnosis of COPD is
exacerbations while also reducing the often missed by primary care physicians and
patient’s overall burden of symptoms. We specialists alike. “Case Finding” has been
begin by reducing risk factors: found to be a cost effective and reliable way to
- The first priority for any treatment plan should identify COPD before the patient ends up in the
be for the patient to stop smoking. hospitali for an acute exacerbation. One
- Further reduce risk by vaccinating against example of case finding in Great Britain found
that for smokers age 40-79 an automated
Influenza, Pneumococcus, and Pertussis
electronic pop-up appearing at the time of a
- Implementation of a stepwise treatment plan
patient visit, reminding the doctor to administer
that includes bronchodilators, inhaled and/or
a COPD screening questionnaire resulted in a
oral corticosteroids, and other
significant increase in the number of new
pharmacological treatments as necessary, cases diagnosed. 3
such as prophylactic antibiotics.
Conclusion
If an ounce of prevention is worth a pound of ● While specific research into the effect of
cure, why do we not screen asymptomatic early screening on the morbidity, mortality
smokers for COPD instead of waiting for and quality of life of asymptomatic patients
symptom onset and exacerbations that can is lacking, we know that COPD is a
land them in the hospital? According to the progressive disease so early diagnosis may
USPSTF, COPD is the third leading cause of help prevent lung tissue damage.
2
death in the United States yet they ● “Case Finding” can provide a cheap and
recommend against screening of effective way to help in the identification of
new patients with COPD
USPSTF there have been no studies to ● Current treatment protocols should be
assess the effect of early COPD screening on continued but individual providers may
2
morbidity, mortality and quality of life consider adding case finding strategies to
their practice.
REFERENCES
1. Tilert, T., Dillon, C., Paulose-Ram, R. et al. Estimating the U.S. prevalence of chronic obstructive pulmonary disease using pre- and post-bronchodilator spirometry: the National Health and Nutrition
Examination Survey (NHANES) 2007–2010. Respir Res 14, 103 (2013).
2. US Preventive Services Task Force (USPSTF). Screening for Chronic Obstructive Pulmonary Disease: US Preventive Services Task Force Recommendation Statement. JAMA. 2016;315(13):1372–1377.
doi:10.1001/jama.2016.2638
3. Jordan, R.E., Adab, P., Jowett, S. et al. TargetCOPD: a pragmatic randomised controlled trial of targeted case finding for COPD versusroutine practice in primary care: protocol. BMC Pulm Med 14, 157 (2014).
https://doi.org/10.1186/1471-2466-14-157
4. Image reference: https://www.healthline.com/health/spirometry