By: George Beauregard, DO
Chief Population Health Officer, SoNE HEALTH
I’m certain that many of you are familiar with patients, friends, and perhaps even family members who are afflicted by this chronic disease, which is a common respiratory condition that affects approximately 10 percent of individuals over the age of 40. Approximately 15 percent of people that smoke get COPD; it can be caused by pollution, undermanaged asthma, poor working environment, or genetics (alpha-1 antitrypsin deficiency). With a prevalence that increases with age, COPD is consistently ranked among the leading causes of death in the United States. Consequent to its high prevalence and chronicity, COPD causes high medical resource utilization—office visits, emergency department visits, hospital admissions, readmissions, and chronic therapies. It’s been well established that many symptomatic people have undiagnosed COPD as well.
The clinical manifestations of COPD are many: a persistent cough, sputum, difficulty breathing, and spirometric airflow limitations. People with a forced expiratory volume in 1 second (FEV1)–indicative of air being trapped in the airways, making it difficult for the lungs to exhale it all out, leaving less capacity for air breathed in–at the low end of the normal range or reduced, as well as an accelerated loss of FEV1 (exceeding 40 ml per year) after age 30 are at risk for developing COPD within 5 years. Chronic tobacco use is a significant risk factor for the development of COPD; smoking cessation can normalize lung function decline. Accordingly, we must be tireless in encouraging smoking cessation and offer support services for that.
A history of exacerbations, especially two or more in a year or an episode requiring hospitalization, predicts future exacerbations and poor outcomes. Of the total cost of care for people with COPD, a disproportionate amount stems from COPD-related hospitalizations, many of which are avoidable.
Certain scoring systems are helpful in managing COPD. The BODE Index (BMI, FEV1 (% of predicted), 6-minute walking distance, and the mMRC Dyspnea Scale) predicts 4-year survival in people affected by COPD.
A pulmonologist should co-manage people with symptomatic COPD. Other clinical support services can also improve their functional status, exercise capacity and tolerance, and quality of life. Recently, SoNE HEALTH initiated a new collaboration with Wellinks, a virtual-first provider of specialty care focused on COPD and concomitant disease management. Wellinks interventions include virtual pulmonary rehabilitation, coaching, medication reconciliation/adherence, personalized care plans, patient activation, and more.
Some medical experts believe that, even without evidence from controlled trials, a chest CT scan should be obtained in most, if not all, patients with COPD to define what phenotype (emphysema or bronchitic) they possess. The CT can also identify early-stage lung cancer.
The National Lung Cancer Screening Trial (NLST) demonstrated a 20% reduction in mortality for lung cancer with the use of low-dose computed tomography (LDCT), providing the first solid evidence that screening can reduce mortality. It’s compelling evidence that we have a screening test that will make a dent in the mortality rate and the 5-year survival rate. It’s time to get behind this evidence-based gold standard and save lives.
