Diagnosis and management of chronic obstructive pulmonary disease (COPD) in a primary care clinic

Chronic Obstructive pulmonary disease (COPD) is an important cause of morbidity and mortality in the United States and internationally. The purpose of this study was to describe spirometry use in the diagnosis of COPD and to evaluate the management of COPD occurring in a primary care clinic.

Two hundred patients with a diagnosis of COPD attending a university-based family medicine clinic were randomly chosen for a retrospective medical record review. Pulmonary function testing, provision of smoking cessation advice and pharmacological management were compared to the recommendations of the Global Initiative for Chronic Obstructive Lung Disease.

Mean age was 65.4 years, 48% were male and 72% were Caucasian. Overall, 58.5% (n = 117) of patients had pulmonary function testing, with 60.7% acknowledged in the outpatient record; 55% (n = 110) were receiving medications in combinations that are recommended; and 40% of patients were receiving stage appropriate medications. 67.8% of current smokers were offered smoking cessation advice or treatment.

Overall there was low use of recommended medication combinations and stage appropriate treatment, with better observance of diagnostic and risk factor reduction guidelines. In order to improve COPD care for patients, physicians need education about the recommended stepwise treatment options and office systems that promote integration of pulmonary function testing findings into care.