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Using spirometry in COPD diagnosis 

September 1, 2011    

Chronic obstructive pulmonary disease (COPD) — an umbrella term for progressive respiratory conditions including emphysema and chronic bronchitis — is a rapidly escalating chronic health problem both in the United States and worldwide. An estimated 13 million Americans have been diagnosed with the disease and nearly twice that number show some degree of impaired lung function. The price tag for COPD is high — direct medical costs reached nearly $30 billion in 2010.1 The human toll is equally steep in terms of disability, poor quality of life, and premature death. Despite the magnitude of the problem, COPD is widely underdiagnosed and under-treated.2

Spirometry testing is a key tool for identifying COPD. This simple, noninvasive airflow measurement can be performed in a primary care physician’s office by properly trained personnel.3 The test compares the volume of air a person can breathe out in one second (forced expiratory volume or FEV1) to the maximum amount that can be expelled in a forced exhalation (forced vital capacity or FVC). A FEV1/FVC ratio that is below 70 percent indicates impaired breathing function and the possibility of COPD. A key characteristic that differentiates COPD from other lung conditions (such as asthma) is that breathing does not improve with bronchodilation. After baseline testing, if the bronchodilator is administered and there is no difference between the two readings, the diagnosis of COPD is supported rather than asthma.2

Between 80 and 95 percent of deaths from COPD are related to cigarette smoking.1 Other high-risk groups include those exposed to second-hand smoke and environmental or occupational pollutants and people with a family history of respiratory disease. Individuals fitting these criteria who exhibit symptoms of cough, sputum production, or dyspnea should be evaluated for COPD. The National Committee for Quality Assurance (NCQA) COPD Initiative recommends spirometry testing for:

  • patients ages 40 or older who have newly diagnosed COPD;
  • patients who have newly active disease (previously diagnosed COPD patients that have not seen a doctor about the disease or had spirometry testing within the two years prior to the current visit).

In both cases, the test should be performed within 180 days of the initial diagnosis or newly active disease.4

COPD is progressive and irreversible. Smoking cessation is the only intervention that has been proven to slow the decline in lung function. By identifying COPD at an early stage, primary care physicians are in a better position to help their patients make this lifestyle change before lung damage becomes severe. Treatment for most patients consists of a step-wise approach to managing symptoms with medications and oxygen therapy based on the stage of the disease.2

We can help

The ConnectionsSM Program offers your patients access to Health Coaches — health care professionals such as registered nurses and registered respiratory therapists — who can offer guidance and support to COPD patients. To learn more about the health coaching services available to your practice, call 1-866-866-4694. You can also refer your patients to a Health Coach by completing the fax referral form that is available online at www.ibx.com/providerconnections.

References: 1American Lung Association. Chronic obstructive pulmonary disease: fact sheet. February 2011. www.lungusa.org/lung-disease/copd/resources/facts-figures/COPD-Fact-Sheet.html

2Global initiative for chronic obstructive lung disease. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. Updated 2010. www.goldcopd.org/guidelines-global-strategy-for-diagnosismanagement.html

3American Thoracic Society. Standards for the diagnosis and management of patients with COPD. 2004. www.thoracic.org/clinical/copd-guidelines/resources/copddoc.pdf

4Health Dialog. COPD initiative: spirometry testing. 2010.

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