According to the National Heart, Lung, and Blood Institute (NHLBI), COPD is leading cause of both disability and death in the United States. As of 2018 16.4 million Americans have been diagnosed with COPD, along with millions more who may have the disease without even knowing they have it.
COPD includes chronic bronchitis and emphysema and is characterized by chronic airflow limitation that is not fully reversible, is usually progressive, and is associated with an abnormal inflammatory response. Spirometry testing is required to make the diagnosis of COPD, assess airflow limitation, and help in determining the severity of the disease. It can be used to monitor specific treatment steps, as well as the progression of the disease (Global Initiative for Chronic Obstructive Lung Disease; GOLD 2019).
Performance is assessed with the NCQA HEDIS measure, “Use of Spirometry Testing in the Assessment and Diagnosis of COPD,” which measures the percentage of members 40 years of age and older with a new diagnosis or newly active COPD, who received appropriate spirometry testing to confirm the diagnosis. This is a priority opportunity for improvement.
COPD symptoms range from chronic cough and sputum production to severe shortness of breath. For stable COPD, pharmacologic therapy is used to reduce symptoms, improve exercise tolerance, and reduce the frequency/severity of exacerbations. Inhaled long-acting bronchodilators are preferred and are more effective for maintained symptom relief. An inhaled corticosteroid combined with a long-acting B2 agonist (LABA) is more effective than either individual component in patients with moderate to severe COPD. Long-term monotherapy with inhaled corticosteroids or long-term treatment with oral corticosteroids is not recommended.
An exacerbation of COPD is defined as an acute event characterized by a worsening of the patient’s respiratory symptoms that is beyond the usual day-to-day variations and leads to a change in medication. Management of exacerbations with pharmacotherapy is an essential component, and decreasing the frequency of exacerbations may slow the progression of COPD. Studies show that inhaled bronchodilators and systemic corticosteroids are the preferred treatment for home/outpatient management of exacerbations (GOLD 2019).
Common challenges to the diagnosis and treatment of COPD include:
Given the above factors, WHA’s quality improvement activities for COPD include:
