Getting to the Bottom of Patients' True COPD Status

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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

Many of the questionnaires used in clinical trials to assess COPD outcomes are rarely used in clinical practice. Instead, Hanania’s favorite line of questioning is to ask patients about their activity levels, such as how much they can walk and how many times they have to stop, and to compare their answers to past responses. He said that this is much better than asking patients how they feel, because they all say they are fine. It is also very important to ask about exacerbations at every visit, which might require using other terminology, he said.

MacIntyre raised the point that when patients go through pulmonary rehabilitation, the clinicians are required to measure change in exercise tolerance, usually the 6-minute walk test. Both patient-centered objective tools and talking directly to the patient are very important to assess the patient’s progress and to find out each individual patient’s triggers, said Make. The COPD assessment test is one useful tool that can be incorporated into electronic medical records, he said.