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Pulmonary function tests essential, underutilized in diagnosing COPD

It is important to confirm diagnosis of COPD with pulmonary function testing; however, it is not often used, according to findings published in Mayo Clinic Proceedings.

In the United States, COPD is the third leading cause of death and causes distressing symptoms, but the disease is treatable, according to Paul D. Scanlon, MD, medical director of the Mayo Clinic Pulmonary Clinical Research Center, and colleagues.

Scanlon and colleagues examined the Global Initiative for Chronic Obstructive Lung Disease (GOLD) report to determine updated assessment and treatment options for COPD.

The researchers identified several important findings:

• Diagnosis should be established via pulmonary function, but it is underutilized.
• Patients with COPD should be vaccinated for influenza and pneumonia.
• Therapy should be based on symptoms and exacerbation frequency rather than pulmonary function or COPD stage.
• Health conditions, such as lung cancer and heart disease, are important to prevent and manage in patients with COPD.
• Education, training and assessments should be included at every visit for COPD.

“The majority of people with COPD have mild disease that requires very little treatment other than smoking cessation and possibly a short-acting bronchodilator,” Scanlon said in a press release. “For the minority of people with more advanced disease, current therapy is very effective, improves symptoms and quality of life, increases exercise tolerance, and reduces frequency of exacerbations.”

Smoking cessation can help to manage symptoms and lower COPD risk regardless of lung function level, according to the researchers. Quitting smoking improves lung function and slows the rate of decline even among those with lung cancer or heart disease, according to the researchers.

Inhaled corticosteroids, combination inhalers, or long-acting bronchodilators reduce the frequency of exacerbations among patients with COPD, they noted.

The GOLD defines COPD obstruction as a forced expiratory volume in 1 second/forced vital capacity ratio of less than 0.7, but Scanlon and colleagues “strongly disagree because of inappropriate overdiagnosis of obstruction in older (> 60 years) patients.”

The researchers noted that COPD is commonly overdiagnosed and underdiagnosed due to lack of appropriate testing, which results in inappropriate therapy and delayed diagnosis of other treatable conditions among many patients.

“In the past, health care providers were pessimistic about treating COPD,” Scanlon said. “With appropriate therapy, those attitudes are outdated.” – by Alaina Tedesco

Disclosures: Scanlon reports honoraria paid to his institution by Boehringer Ingelheim and GlaxoSmithKline, royalties paid by Wolters Kluwer Lippincott and grant support from AstraZeneca, Boehringer Ingelheim, Forest Laboratories, GlaxoSmithKline, Novartis Pharmaceuticals, and Pearl Therapeutics paid to his institution. All other authors report no relevant financial disclosures.