Office management of COPD in primary care: a 2009 clinical update

Primary care physicians (PCPs) usually are the first to diagnose and care for patients with chronic obstructive pulmonary disease (COPD). This article discusses key teaching points of recently published guidelines for PCPs and the common challenges of treating COPD patients in a primary care setting, and clarifies common misconceptions. First, PCPs should choose one of the published screening tools to assess for COPD. Spirometry is a useful tool to confirm the diagnosis of COPD to distinguish COPD from asthma, to stage the disease for determining treatment, and it can help with smoking cessation efforts. Chest radiographs do not help to diagnose COPD but are useful to rule out other causes of dyspnea and cough. Differentiating COPD from asthma is important because it affects treatment decisions and prognosis. Second, the goals of COPD treatment are to relieve symptoms, improve exercise tolerance, prevent exacerbations, and improve quality (although not necessarily extend quantity) of life. Chronic obstructive pulmonary disease can be treated at any stage, and the treatments are adjusted in a stepwise approach based on disease severity. Third, as part of the long-term management of COPD, smoking cessation should be discussed at every visit, and inhaler technique should be reviewed at regular intervals. Chronic obstructive pulmonary disease patients should also receive the recommended influenza and pneumococcal vaccinations. Primary care physicians are in a unique position to identify COPD patients early, to implement primary and secondary preventive measures, and to provide care that addresses the full spectrum of COPD and its comorbidities.