Global mortality rates from COPD are projected to increase by 30% over the next decade, and by 2030, COPD will be the third leading cause of death, Primary care clinicians often are the first providers to see a patient with COPD and may be the only clinicians to treat those patients.

Accurate diagnosis, particularly differentiation from asthma, is the cornerstone of effective management. Spirometric assessment is the best and most accurate method for diagnosing COPD. Spirometry should be performed before and after bronchodilator therapy: if the patient has asthma, the forced expiratory volume in 1 second (FEV₁) usually returns to normal after therapy, whereas in COPD “values rarely, if ever, return to normal.” Yet spirometry is underused in primary care practices.

If the patient has 10 to 20 pack-years of smoking, and you think they may have COPD, you need to rule it out with spirometry.”

Patient education, regular monitoring of inhaler technique and pulmonary rehabilitation are the mainstays of management for stable COPD. Because smoking is the leading cause of COPD, clinicians should urge patients to quit if they have not already done so. Education also should cover avoidance of other risk factors, such as pollutants and occupational chemicals, and good adherence to the medication regimen. Patient’s family should be included in any educational efforts, especially when it comes to taking medication.

Careful attention to inhaler technique is essential, given evidence that up to 94% of patients use their inhalers incorrectly.

There are a lot of places that offer outpatient asthma education, and you can send your patient there so a respiratory therapist can review that with them. Or, if you’re in a group practice, you can assign one of the nurses to teach them how to use it. A bronchodilator challenge is part of the spirometry test, so you can use that opportunity to start teaching them how to use the inhaler.”

Pulmonary rehabilitation is a comprehensive therapy for COPD and includes exercise training, self-management education, and psychosocial and nutritional education and intervention .The number of available pulmonary rehabilitation programs is very limited and people just aren’t doing it.  Low reimbursement levels may be the culprit behind the shortage.

COPD is now considered “preventable and treatable,” and effective management can have an important impact on the length and quality of a patient’s life. Because most patients with COPD are now treated solely by their primary care clinicians, those clinicians should have the most up-to-date information on management strategies. “The goal is to have the patient go from a passive recipient of instructions, to an informed, active participant in their care,”

Ref; http://www.medscape.org/viewarticle/736896?src=cmemp