Social Determinants of Health (SDoH) Impacting Treatment and Management of COPD

Social determinants of health (SDoH) can create major barriers for access to care.

Jeffrey D. Dunn, PharmD, MBA: Right now, there’s a hot topic: social determinants of health. We see that a lot. I’m not sure everybody fully understands that, but there are a lot of people involved in these types of programs. How do they impact this particular disease state? How do we approach it in terms of treatment management?

Mike Hess, MPH, RRT, RPFT: From a respiratory therapy and public health perspective—which is how I come at it—I look at social determinants as the things outside the directly clinically modifiable things that affect your health. These are things like your housing situation, your environment, and your neighborhood.

Looking at it through that lens, people with COPD [chronic obstructive pulmonary disease] are hit with a double whammy. People with low socioeconomic status are often the ones who are most prone to smoking. They’re the most likely to have poor air quality in their environment. They’re more likely to have irritants in their home that can cause problems in their lungs all around. Once they have developed these symptoms and once they’re diagnosed, they also have the greatest barriers to obtaining care. They have difficulties obtaining the diagnosis to begin with because they have difficulty getting to the proper clinicians to get the diagnosis. They may not be able to afford their medications. They often don’t have great health literacy, so they may not understand exactly how to take their medications.

Unfortunately, as we learn more about COPD, we’re also learning that it isn’t only the social determinants of care as an adult. It extends back into youth. The environment that you live in when you’re younger in addition to genetics can affect the trajectory later on in life. As Rey pointed out, the main risk factor is tobacco smoke, but we also have to start looking back further and seeing what other pollutants and exposures are there. Have you been exposed to biomass? We have low socioeconomic places in this country. I live in Michigan, where a lot of folks are using biomass for heat and cooking, especially in more rural areas. They’re tightly tied together, and it comes at it from both the pathogenesis and therapy sides.

Jeffrey D. Dunn, PharmD, MBA: We’ll probably come back to this in a little while, but how do we address that? How does that change what we do with different patients?

Mike Hess, MPH, RRT, RPFT: It’s difficult because it’s easy to identify the problem, wave a magic wand, and say, “This is how we fix it.” One of the best things we can do is to start looking for COPD from an earlier age. This has often been diagnosed well after a lot of the damage has been done in the lungs, after people have developed symptoms and already started to adapt their lifestyles to them. The most immediate impact we could have is by getting clinicians to look at screening and diagnosis much earlier, even in patients in their 30s and 40s. We may not be able to influence the trajectory at that point, but we can get these things on our long-term radar so that we can take care of people better down the line.

Jeffrey D. Dunn, PharmD, MBA: Perfect. That’s a perfect recommendation. That was a great overview of COPD. I’ll try to summarize it, and then you guys jump in and tell me if I’ve missed high-level points. COPD is different from asthma. Fortunately, the biggest risk factor for COPD is smoking, which is modifiable. COPD is different from asthma in that it’s multisystemic, it has a high clinical and economic burden, and that different social determinants of health play a role in terms of who gets access to therapies and how they’re screened, identified, and treated. Is that a fair summary?

Reynold Panettieri, Jr, MD: Well said.

Transcript edited for clarity.

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