The Cost of Delay: Why Early COPD Diagnosis Matters in Primary Care

This post was authored by Jonnie Korinko, MSRC, RRT, RRT-ACCS.

It is well-established that COPD is underdiagnosed.^1-3 When COPD is diagnosed early in its progression, it is linked to fewer exacerbations and lower healthcare costs.⁴ Increasing diagnosis in primary care can help people living with COPD manage their lung condition, allowing for early treatment and improved quality of life.

The Importance of Diagnosing COPD in Primary Care

Defining the prevalence of COPD can be difficult, as the diagnosis is dependent on the presence of post-bronchodilator spirometry. While less than six percent of the national population reports a COPD diagnosis, it is understood that this number misrepresents the burden of COPD, as spirometry is inaccessible or underutilized in many populations.⁵ Globally, it is estimated that 10.3% of the population live with COPD.5 COPD is listed as the sixth leading cause of death, accounting for approximately 4.5% of overall deaths in adults in the United States in 2022.⁶

Similarly, an estimated 90% of people with alpha-1 antitrypsin deficiency (AATD), a common form of genetic COPD, are not diagnosed.⁷ AATD classically results in panacinar emphysema, even when the person with the genetic condition does not have a tobacco smoking history. Other clinical manifestations of AATD include liver disease, panniculitis, bronchiectasis, and Wegner's granulomatosis.⁷ It is recommended that all people who have been diagnosed with COPD undergo AATD testing.⁷ Underdiagnosis of COPD contributes to the underdiagnosis of AATD.

Primary care providers serve as the first point of contact for respiratory patients when they experience symptoms. They play a critical role in identifying symptoms and detecting COPD and AATD. With timely diagnosis of these conditions, patients can start appropriate treatment, which improves their symptoms and quality of life.^5,7

Barriers to Diagnosing COPD in Primary Care

Arguably, one of the most significant barriers to the diagnosis of COPD is awareness of the condition.⁸ Early symptoms of COPD are commonly attributed to aging or other chronic conditions - chronic dyspnea and a cough with or without mucus.⁵ Similarly, the knowledge of COPD risk factors, diagnosis, and progression may not be understood by people experiencing pulmonary symptoms. When they appear "healthy," they are less likely to be screened for COPD, even when a smoking history is present.⁸

As it stands, significant barriers exist to implementing accurate spirometry within primary care centers, as both accurate, calibrated spirometers and trained technicians are required for accurate results.⁹ A COPD diagnosis without spirometry can lead to an incorrect diagnosis of COPD, which prevents effective treatment.^1,2 In the absence of spirometry available within the primary care setting, a referral can be made for pre- and post-bronchodilator spirometry to be performed at a facility with standardized equipment and appropriately trained staff.

Addressing Barriers and Improving Diagnosis

By identifying and diagnosing people with COPD early, symptom management can start sooner, reducing the risk of exacerbation. This approach minimizes healthcare costs for these patients and enhances their quality of life. Screening in medical practices may help identify existing patients at risk for COPD and would benefit from spirometry.⁸ Once the COPD diagnosis is made, testing for AATD, a common form of genetic COPD, is imperative to improve the impact of its underdiagnosis and address treatment barriers.

There are many resources available to assist clinicians working in the COPD community:

• The Praxis Resource Repository is a library of up-to-date research and educational materials to benefit clinicians working in the COPD community. Be informed of the latest research and resources to keep your community safe and healthy.
• Engage in continuing medical education (CME) specific to COPD care. Our partner learning opportunities are listed on our Professional Development website.
• Listen to the COPD Foundation Podcast. Here, the educators at the COPD Foundation discuss COPD management with leading physicians in COPD management.
• The International Primary Care Respiratory Group (IPCRG) has numerous free resources designed to assist primary care providers in optimizing the diagnosis and treatment of COPD.
  • Desktop helpers are printable guides to common challenges in primary care.
  • The COPD Right Care Wheel is a printable guide that assists primary care providers in the accurate diagnosis and treatment of people with COPD and assists them in having conversations with their patients.

Primary care providers are the front lines at recognizing symptoms of COPD. Identifying barriers to diagnosis is the first step in implementing strategies to improve timely diagnosis and treatment of chronic lung disease. When COPD and AATD is diagnosed early, the burden of the condition is lessened.