COPD Outcomes Beyond Spirometry

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The MD Magazine Peer Exchange “Expanding Treatment Options: The Latest Developments in COPD Therapy” features a panel of physician experts discussing key topics in COPD therapy, including risk factors, personalized treatment, preventive measures, new combination therapies, and more.

This Peer Exchange is moderated by Peter Salgo, MD, professor of medicine and anesthesiology at Columbia University and an associate director of surgical intensive care at the New York-Presbyterian Hospital in New York City.

The panelists are:

• Byron Thomashow, MD, professor of medicine at Columbia University Medical Center, medical director at the Jo-Ann LeBuhn Center for Chest Disease at New York-Presbyterian Hospital, and chairman of the board of the COPD Foundation
• Neil R. MacIntyre, MD, clinical chief of the Pulmonary/Critical Care Division, medical director of Respiratory Care Services, and professor of medicine at Duke University School of Medicine
• Barry J. Make, MD, director of Pulmonary and Respiratory Care for National Jewish Health and professor of medicine at the University of Colorado School of Medicine
• Nicola A. Hanania, MD, MS, associate professor of medicine and director of the Asthma and COPD Clinical Research Center at Baylor College of Medicine

In addition to pharmacotherapeutic options, patients with COPD can also benefit from therapies that are not pharmaceutical, such as pulmonary rehabilitation, which is rarely used but is inexpensive and improves quality of life. Barriers to its uptake include low reimbursement, said Thomashow, and the inability to get patients to commit to a lifestyle change, said MacIntyre.

In terms of deciding what is helping a patient, there are many different criteria that can be used. FEV1 alone gives an inadequate picture of the disease’s impact on patients according to the GOLD COPD guidelines. MacIntyre agreed that spirometry is a crude and oversimplified index, especially since it measures little of the airway properties of the more distal lung, which is where COPD is most rampant. Instead, he said that symptoms are important, as well as the COPD assessment test from the Medical Research Council in the United Kingdom. In addition, he mentioned questionnaires about quality of life and impact on daily living, as well as depression scores and exacerbation rate.