COPD, as the sixth leading cause of death in the US, is widely seen as a preventable epidemic. However, shortcomings in public policy and healthcare hinder access to timely and accurate diagnosis, as well as effective specialty care. We must prioritize expanding access to early screening, diagnosis, and continuous care to mitigate disease progression and save lives. November’s National COPD Awareness Month is the perfect time to propose a 4-point plan to support patients and accelerate early diagnosis.
The silent epidemic
COPD is known to be a ‘silent epidemic’: impacting over 25 million adults in the U.S. Data shows that up to 50% are living without a proper diagnosis, meaning they’re going overlooked and untreated by the healthcare system. There are several reasons why the disease hasn’t been addressed on a national scale:
- Public policy shortcomings: COPD is one of the leading causes of preventable death and disability, yet public policy does not prioritize access to affordable COPD medications, pulmonary rehabilitation programs, or sufficient funding for COPD awareness and education.
- Lack of access to spirometry: The lack of widespread use of spirometry, the diagnostic test used to confirm COPD, results in underdiagnosis or misdiagnosis. Consequently, undiagnosed individuals may not realize they have COPD until it has reached a more severe stage, resulting in more acute symptoms, complex cases, and worse outcomes.
- Costly comorbidities: COPD tends to occur more frequently in patients over the age of 65, and over 80% of people with COPD have at least one comorbidity. When comorbidities are present, medical costs are five times higher for COPD patients, and as patients age, the comorbidities often become more complex. One of the most commonly occurring comorbidities is heart failure, which is closely linked to COPD exacerbations. Thus, it’s not surprising that both COPD and heart failure represent the top fourth and second diagnoses. respectively, for hospital readmissions.
- Declining number of specialists: As physician retirements increase across the board, there is a particularly concerning shortage of pulmonary specialists. As a result, patients in areas without convenient access to pulmonologists may have to travel up to 100 miles and wait up to four months for an appointment.
- Access to care in rural markets: Americans in rural areas face a variety of challenges when it comes to accessing healthcare. For COPD in particular, rural Americans face higher diagnosis and mortality rates, due to difficulties traveling to, affording, and consistently accessing timely and high-quality specialty care.
The four-point plan to address COPD
- Drive more awareness: The first step in addressing the silent epidemic of COPD is to raise awareness. Organizations like the COPD Foundation are instrumental to educating the public about the risk factors and symptoms of COPD. They emphasize the importance of early diagnosis and treatment, shedding light on a condition often overshadowed by more high-profile health concerns. However, there remains a critical need for robust anti-smoking campaigns, clean air regulations, and increased funding for COPD awareness and education. It’s time for public policy to prioritize adequate reimbursement for spirometry testing, including home based testing, affordable COPD medications, remote pulmonary rehab, remote self management programs, and other evidence based COPD care.
- Prioritize Diagnosis and Screening: To address the diagnostic shortfall in COPD, we must improve access to and utilization of spirometry so that physicians and individuals alike can assess and confirm the condition before it progresses. Just last month, the American Lung Association issued a new COPD State Brief recommending the use of a COPD screening tool and spirometry to confirm diagnosis. In recent years, there has been significant investment in at-home solutions for spirometry that can produce high-quality readings without the need for a clinic. We have seen an increase in the ability to do spirometry from the home environment, often producing equally high quality readings as seen in clinic. Combining home-based spirometry with the CAPTURE screening tool, which uses a combination of questions and peak expiratory flow (PEF) rate, will empower providers and patients to diagnose and care for COPD from home.
- Leverage monitoring devices and wearables: As we embrace a future of connected healthcare, monitoring devices and wearables play a pivotal role in managing chronic conditions like COPD. These devices enable healthcare providers to keep a close eye on a patient’s conditions, tracking important metrics, and intervening promptly when necessary. By incorporating, Bluetooth connected devices such as spirometers, pulse oximeters, and inhaler trackers into clinical management, we can empower patients to take a more active role in their own care. Regular monitoring of patient’s conditions can detect exacerbations while uncovering rising risk, helping to prevent hospital admissions and readmissions while improving overall quality of life. In a world increasingly reliant on technology, we must harness these tools to address COPD comprehensively.
- Embrace Virtual Care: The emergence of the Covid- 19 pandemic accelerated the adoption of telehealth services and virtual care practices. COPD patients, who are often elderly or living in rural areas, benefit immensely from the accessibility and convenience that virtual care provides, including telehealth appointments and ongoing disease monitoring. Likewise, telehealth can mitigate the shortage of pulmonologists and the extended waiting times for specialist appointments. Virtual care not only ensures timely access to care but also enables continuous monitoring and early intervention. Patients can receive timely check-ups, participate in pulmonary rehabilitation programs, and seek advice, all from the comfort of their homes, eliminating the burden of transportation costs and time. This trend in virtual care must continue to expand to ensure that all COPD patients receive the care they deserve.
Urgent action is necessary
To summarize, the silent COPD epidemic demands urgent recognition and action. The four-point plan offers a holistic strategy for tackling this critical public health issue through increased awareness, emphasis on diagnosis and screening, utilization of monitoring devices, and the adoption of virtual care. In this way, we can revolutionize the landscape of COPD management, slowing disease’s progression and potentially saving numerous lives.. The time for decisive action has arrived.
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