COPD Management CPG

Chronic obstructive pulmonary disease (COPD) is currently the third leading cause of death in the United States. COPD caused an estimated 134,676 deaths in the United States in 2010. The disease reduces life expectancy and is one of the more significant conditions that impacts comorbidity-adjusted life expectancy. According to 2013 data from the Behavioral Risk Factor Surveillance System, 12.3% of US adults aged 75 years or older have been told by a physician that they have COPD. Unrecognized early disease is common because COPD is usually not diagnosed until it is clinically apparent and moderately advanced; prevalence and morbidity data tend to underestimate the total burden of the disease. For example, 12.7 million US adults (aged 18 and over) were estimated to have COPD in 2011, whereas close to 24 million US adults have evidence of impaired lung function, indicating an under-diagnosis of COPD. COPD is estimated to affect 14.2% of adults aged 65 and older, and studies suggest that one of every six patients admitted to PALTC facilities may have a history of emphysema or COPD. In 2004, 10% of Medicare recipients in California who had COPD were admitted to a skilled nursing facility. In a Medicaid COPD population, approximately 22% of respiratory-related health care costs were nursing home costs.

Among the outcomes that may be expected from the implementation of this clinical practice guideline are earlier identification and better differential diagnosis of COPD; improved staff satisfaction and confidence in the ability to manage COPD; more appropriate use of oxygen therapy and medications to treat COPD (resulting in improved resource utilization and decreased patient care costs); reductions in the prevalence of smoking in the facility; and reductions in the frequency of acute exacerbations and avoidable hospitalizations secondary to COPD.