Chronic Obstructive Pulmonary Disease (COPD)

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.

Pharmacotherapy Management

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: 

1. Under-diagnosis and misdiagnosis: confusion with Asthma and Asthma-COPD Overlap Syndrome
2. Lack of spirometry/lung function testing to determine severity of the disease
3. Lack of guideline use
4. Removing or reducing triggers (e.g., smoking)
5. Medication adherence, and poor communication among treating practitioners, pharmacists, and health plans in identifying members non-compliant with medications 

Given the above factors, WHA’s quality improvement activities for COPD include:

1. Increasing members’ awareness and knowledge about the prevention and management of COPD. November is National COPD Awareness month, and the NHLBI COPD Learn More Breathe Better campaign resources are available online.
2. Increasing primary care providers’ knowledge of and access to current Clinical Practice Guidelines (CPGs), as they have a key role in the diagnosis and management of COPD. Practitioners can find the GOLD “Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease” (2017) CPGs at mywha.org/CPGs.