Implementing COPD Pulmonary Function Tests at the Point of Care

COPD is the third leading cause of death in the United States, with millions diagnosed and an additional 12 million who may remain undiagnosed. Beyond the personal burden for patients and families, the economic burden of COPD is estimated to reach $50 billion by 2020. To date, most patients with COPD are not diagnosed with the disease until they have lost 50% or more of their lung function.

Suspicion of COPD is essential to enhancing outcomes of the disease among individuals aged 40 and older with dyspnea, especially for those with progressive dyspnea with exertion or with chronic productive cough and a history of smoking. Spirometry or pulmonary function testing can confirm COPD, assuring an accurate and timely diagnosis, but these tests are not available in many primary care offices. This means that physicians may need to send patients to an outside lab for lung function testing. Patients are often unable or unwilling to go to an outside site for this initial testing.

In-office spirometry testing and diffusion capacity (D_LCO) assessment could facilitate and confirm a diagnosis of COPD. However, research suggests that these tests continue to be underutilized due to lack of equipment, concerns about cost, lack of knowledge, or a combination of these factors.

The Solution

To address the growing number of COPD sufferers, it is crucial for primary care physicians and pulmonologists to provide reliable lung function testing so that the disease can be detected earlier. This testing would also enable clinicians to get accurate diagnoses and assist with the development of personalized treatment planning to optimize patient outcomes.

The Global Initiative for Obstructive Lung Disease guidelines recommend using spirometry as one of the primary tools to establish a COPD diagnosis in patients with a history of prolonged cough, difficulty breathing, and exposures to risk factors, such as smoking. Spirometry can assess the forced expiratory volume and forced vital capacity that are essential to making a COPD diagnosis.

The addition of D_LCO assessment to spirometry provides additional information that may better inform a COPD diagnosis. D_LCO testing measures the ability of the lungs to transfer gas from inhaled air to the red blood cells in pulmonary capillaries. It can help differentiate pulmonary from cardiac issues and COPD from asthma. It can also identify whether or not significant emphysema is present. D_LCO testing is an important predictor of survival in patients with COPD. The combination of spirometry and D_LCO testing allows clinicians to accurately diagnose and treat chronic lung disease at the point of care.

Improving Outcomes for Patients & Physicians

Offering spirometry and D_LCO testing at the point of care is beneficial for both patients and physicians. Patients can be tested in the familiar and convenient setting of their doctor’s office and will not need to visit another site for lung function tests. Onsite testing can increase patient satisfaction and adherence to completing necessary lung function evaluations. Physicians who invest in adding spirometry and D_LCO testing to their practice will benefit from receiving real-time results. This can lead to the initiation of more immediate treatment, based on an accurate diagnosis. It can also decrease patient transport costs and wait times and increase office income streams. The simplicity and ease of use of newer, portable spirometry and D_LCO testing can improve workflow, enhance the accuracy of test results, and increase overall efficiency.

With spirometry plus D_LCO testing available at the point of care, physicians have the opportunity to better detect, diagnose, and treat patients with COPD, while reducing patient and economic burden of lung function assessment across the entire healthcare system.

Barbara P. Yawn, MD, MSc, MSPH, has indicated to Physician’s Weekly that she has no financial disclosures to report.