Lou Portero

Urban Health Today

A study published in the Lancet Regional Health &#8211; Americas revealed that many people diagnosed with chronic obstructive pulmonary disease (COPD) who are at high risk of exacerbations are not receiving recommended care. 
Despite national initiatives aimed at reducing COPD prevalence over the past two decades, the disease remains a significant public health concern in the United States. For this study, Dr. David Price and colleagues compared the management of patients with high-risk COPD in the United States to national and international guidelines and quality standards.
The researchers categorized the patients into three high-risk groups based on their COPD diagnosis status: newly diagnosed (within 12 months of diagnosis), previously diagnosed, and those suspected of having undiagnosed COPD.  All groups included patients with a history of exacerbations or factors suggesting a high likelihood of future exacerbations of COPD.
There were about 16012 newly diagnosed high-risk patients, 54580 previously diagnosed high-risk patients, and 40202 with probable high-risk COPD. About 60% of patients were women, and most were in their mid-60s.
The study found racial disparities in COPD diagnosis among high-risk patients. Black individuals were significantly less likely to receive a COPD diagnosis (less than 10%) compared to those having potentially undiagnosed COPD (23%). Conversely, white patients had a prevalence of diagnosed COPD (77.1% &#8211; 78.0%) compared to those with potential undiagnosed COPD (71.2%).
“This suggests race is a factor in diagnosing patients, which aligns with previous studies reporting the ongoing racial disparities in respiratory outcomes and the importance of considering the social and economic context when addressing patient barriers to care,” the researchers wrote.
The study also revealed that among the patients who met the high-risk criteria in 2019, nearly half (42.7%) had no documented review of COPD symptoms by a healthcare professional in the year before or after diagnosis.
In addition, over 80% of patients, including both newly diagnosed and previously diagnosed cases, lacked a record of a recent spirometry test, a key diagnostic tool for COPD.
“Diagnosis without spirometry may contribute to overdiagnosis and ill-fitted treatment,” Dr. Price and team wrote.
Even more concerning, the researchers found that over half of the high-risk patients with a confirmed COPD diagnosis had no record of being prescribed inhaled therapies, a cornerstone of COPD treatment. In addition, more than 90% of diagnosed patients had no record of a recent assessment to check heart health or any existing health conditions potentially associated with medication use.
“Despite effective medication options being available, a surprising proportion of newly diagnosed and already diagnosed&#8230; patients at high risk had no evidence of receiving a prescription for inhaled maintenance therapy,” the researchers wrote.
Source: <a href="https://copdnewstoday.com/news/many-high-risk-us-copd-patients-not-getting-recommended-care-study/">COPD News Today</a>
Journal: <a href="https://www.sciencedirect.com/science/article/pii/S2667193X23001205#abs0010">Lancet Regional Health &#8211; Americas</a>

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High-Risk COPD Patients Not Getting  Needed Care

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people diagnosed with chronic obstructive pulmonary disease (COPD) who are at high risk of exacerbations are not receiving recommended care