Explore What's Possible: Achieving Optimal COPD Management

December 26, 2019

Thomas C. Corbridge, MD, FCCP, is a GSK medical expert and an emeritus physician and adjunct professor of medicine at Northwestern University, Feinberg School of Medicine in Chicago, Illinois. Dr. Corbridge received his medical degree from the University of Chicago Pritzker School of Medicine and has been in practice for over 30 years. Dr. Corbridge specializes in pulmonary and critical care medicine and is experienced in asthma, chronic obstructive pulmonary disease and general pulmonology.

Chronic obstructive pulmonary disease, or COPD, is an incurable but treatable lung disease that affects approximately 27 million people in the United States.1 In fact, it is the fourth leading cause of death, but is a silent epidemic, in part due to the negative societal view of this disease. With such a staggering number of people impacted by COPD, and diagnoses on the rise every year, it’s critical that the medical community break down the barriers to appropriate disease management.

Recently, GSK convened a group of COPD advocates including a patient, a caregiver, and other healthcare providers (HCPs) for a discussion about understanding and evaluating the ways we treat COPD. In short, we wanted to uncover the important role that each of us play in ensuring that patients are receiving the best care possible. Not only did the conversation produce many interesting insights and perspectives, it helped outline clear steps that the medical community can take to address COPD moving forward.

Encouraging an open and honest patient-provider relationship

Studies show that 81% of people living with COPD have already reached a moderate or severe stage of the disease at the time of their diagnosis.2 With symptoms ranging from shortness of breath to fatigue, it’s easy for people to dismiss these as signs of aging or lack of exercise. As HCPs, we need to help our patients distinguish between what may be normal signs of aging and what are symptoms of disease.

COPD can also lead to guilt and embarrassment from feelings of shame and blame due to the stigma associated with this disease. In fact, 9 out of 10 people with COPD admit they are not completely open with their doctor when discussing their symptoms — indicating a reluctance to share the impact it has on their lives. Having a relationship with your patient is critical to help break down those walls and overcome negative feelings.

If a patient is coming into the doctor’s office frequently with chronic respiratory infections, struggling to breathe, or claims they have a “smoker’s cough,” take notice and use diagnostic tools like spirometry to establish an initial diagnosis. These symptoms are never normal and suggest that there is more than meets the eye.

I also encourage all HCPs to ask probing questions as part of their regular practice when assessing patients to uncover the real impact of their symptoms and what may have changed since their last visit. Don’t stop when you hear, “I’m fine.” Instead, ask specific questions about activities that you know disrupt lung function and breathing: Are you collecting your mail from the mailbox each day? Are you able to walk the bleachers at your grandchild’s football game? Simple validated tools such as the modified medical research council scale and COPD assessment test can also help HCPs avoid under recognizing their patient’s symptoms.

Elevating the response to an exacerbation or flare-up

We know exacerbations can lead to a decline in quality of life and an increase in risk of mortality. Having 1 COPD attack puts individuals at higher risk of having another, and studies have shown that each exacerbation can cause more lung damage and reduce lung function. Even more alarming, about 50% of exacerbations are not reported to HCPs, suggesting that patients are not seeking the appropriate care.3 When patients under report exacerbations, their physicians may under recognize this critical aspect of their disease and as such, not provide them with optimal treatment and prevention strategies.

It’s time we change the way we approach the treatment of COPD exacerbations and elevate their clinical management to mirror the prevention efforts and response to a heart attack. When a person has a heart attack, they are quickly assessed and managed in a protocolized manner by a specialist to offer every opportunity for recovery, which might include an interventional procedure, appropriate medications, a cardiac rehabilitation program of exercise, nutrition and education. However, if a person experiences a COPD exacerbation — or a lung attack – there are fewer protocols in place and there is less emphasis on pulmonary rehabilitation and a comprehensive management plan to help a patient’s recovery or prevent a future attack. Let’s collectively – patients, caregivers, advocates and providers – appreciate just how significant these lung attacks are. To illustrate this point, in one study looking at 1.2+ million hospital admissions for COPD, mortality at one year for patients 65 years and older was approximately 26%. The average one-year mortality rate among those hospitalized with non-specific chest pain was roughly 3%.4, 5

It's also imperative that we encourage patients to recognize and avoid their COPD triggers. While attacks are not always preventable, there are ways to avoid them and their negative consequences. Patients should also contact their doctor at the first sign of an attack so appropriate treatment can be started as soon as possible.

Optimal treatments for addressing COPD

The goals of COPD treatment right now are to slow disease progression, treat symptoms, and prevent exacerbations. When administered early, appropriate intervention can maintain lung function for longer and improve quality of life. We must understand what triggers our patients’ attacks and mitigate risk for another with disease management plans personalized to our patients’ needs and goals.

As with all treatment decisions, it is important to be able to fully characterize a patient’s disease and determine what options offer the most benefit. To do this, we need to utilize both non-pharmacological and pharmacological treatments. I always recommend exercise to my patients, as it can improve shortness of breath, exercise ability, and decrease anxiety and depression. Staying up to date on vaccinations is also essential — especially the flu vaccine, as people living with COPD are at higher risk of severe complications from flu.

There is also increasing evidence for the use of dual bronchodilator therapy in COPD management. Studies have shown that LAMA/LABA combinations result in improvements in lung function, exercise capacity, and breathlessness, as well as, reduce exacerbation frequency. Additionally, the use of rescue medication is consistently reduced in patients receiving dual bronchodilator therapy, compared with those receiving monotherapy or a placebo.6 Further, among those patients at risk for an exacerbation, evidence demonstrates the benefit of adding an ICS to a LAMA/LABA.

We need to start talking about COPD. With many patients not getting diagnosed until they’ve lost significant lung function, it is critical to remove the stigma associated with the disease, so patients feel comfortable seeking help and being open and honest with their HCPs.7 Equally important is improving early recognition and accurate assessment of symptoms and exacerbations. There has been considerable work already done in this regard with the COPD National Action Plan, but it is incumbent on all of us to continue building awareness around COPD. Each of us plays a role to ensure everyone living with this condition receives the best support and treatment available to live a life full of the things they love.

Additional COPD information and resources for patients can be found at COPD.com. To view highlights of the COPD summit, visit US.GSK.com/COPD.

References

  1. Journal of Occupational and Environmental Medicine. Prevalence of Chronic Obstructive Pulmonary Disease Among US Working Adults Aged 40 to 70 Years. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4555867/. Last accessed December 2019
  2. Mapel DW, et al. Int J Chron Obstruct Pulmon Dis. 2011; 6:573-81
  3. Seemungal TA, Donaldson GC, Bhowmik A, Jeffries DJ, Wedzi-cha JA. Time course and recovery of exacerbations in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2000;161(5):1608—161
  4. Lindenauer PK, et al. Am J Respir Crit Care Med. 2018 Apr 15;197(8):1009-1017. Available at https://www.ncbi.nlm.nih.gov/pubmed/29206052. Last accessed August 2019.
  5. Ruddox V, et al. BMC Medicine 10. Article 58. 2012 June 12. Available at https://bmcmedicine.biomedcentral.com/articles/10.1186/1741-7015-10-58. Last accessed: August 2019.
  6. Anzueto A., et al. Am J Med, 2018; 6:608 - 622
  7. Cedar Sinai. Chronic Obstructive Pulmonary Disease (COPD). Retrieved February 11, 2019 from, https://www.cedars-sinai.edu/Patients/Health-Conditions/Chronic-Obstructive-Pulmonary-Disease-COPD.aspx