COPD Stakeholder Summit: Utilizing Peak Inspiratory Flow Rates to Individualize Treatment and Improve Outcomes - Episode 17
Strategies that can be used to navigate through current barriers associated with screening patients for chronic obstructive pulmonary disease during the coronavirus pandemic.
Neil Minkoff, MD: As we’re starting to wind down a little, I want to make sure something that was touched on doesn’t fly under the radar. A few people talked about the appropriate next step for screening in patients with COPD [chronic obstructive pulmonary disease] to follow up their underlying disease. I see Dr Drummond is already nodding his head, so I’ll ask him to kick off that discussion.
M. Bradley Drummond, MD, MHS: When we think about making a diagnosis of COPD, COVID-19 [coronavirus disease 2019] is a barrier to our standard diagnostic criterion, spirometry testing, which has changed our landscape. It’s considered an aerosol-generating procedure, which may increase risk of somebody who is an asymptomatic carrier of the virus who could spread it easily in an office setting. It’s been difficult to get widespread dissemination of in-office spirometry because of the training requirements, logistic barriers, and the reimbursement rates. Thinking about identifying our patients, I’m very excited about some of the newer approaches that may use things like symptom-based screening plus expiratory flow measurements, which is similar to what we can do in asthma to try to identify patients who may have COPD. We can then think about how we follow those patients long term once we’ve initiated a pharmacotherapy regimen or a pulmonary rehabilitation regimen.
In our general practice, the GOLD [Global Initiative for Chronic Obstructive Lung Disease] treatment strategies recommend doing spirometry testing every year. To be honest, we find that a little burdensome for patients, and oftentimes it may not change how we treat our patients. We have a little more conservative timeline for when we do updated spirometry, but we do use it in situations where we’re trying to understand why a patient may not be responding to a specific pharmacotherapy. We’re going to have to think creatively about what that looks like going forward as COVID-19 has changed our ability to screen and monitor these patients with COPD.
Neil Minkoff, MD: Does anybody else want to weigh in? Please.
Michael Hess, MPH, RRT, RPFT: Another huge component of it is the advocacy and awareness piece, something that often goes overlooked by clinicians. People will adapt. If you have somebody who quit smoking 20 years ago and now they’re at the point in their age-related lung progression where they’re starting to experience symptoms, COPD might not be front of mind. I think it was Dr Drummond who mentioned earlier that a lot of times people just feel, “I’m getting older” or “I’m getting out of shape because I’ve been sitting around for 6 months.” We need to start getting people to think more about their lung health, particularly with COPD.
Pretty much everybody knows October is Breast Cancer Awareness Month. We have pink ribbons everywhere, and everything is pink. After that, November is COPD Awareness Month, but you don’t see nearly as many orange ribbons out there. It’s really important for any clinician, family member, or anybody else who’s involved in the COPD community to take whatever opportunity they can—not only in November but every month—and to get people thinking about their lungs so we can make better progress in identifying patients early, starting treatment a little earlier, and slowing the progression.
This activity is supported by an educational grant from Boehringer Ingelheim.