Primary Care Providers’ Knowledge and Beliefs about COPD

Survey of 426 Primary Care Providers about COPD

Background: Primary care physicians, nurse practitioners, and physician assistants provide the majority of care for those who have COPD. Thus, it is important to ask these primary care providers about their overall knowledge and beliefs about diagnosis and treatment of COPD.
Dr. Barbara Yawn of the Olmstead Medical Center in Rochester, MN

Dr. Barbara Yawn of the Olmstead Medical Center in Rochester, MN

Study: Barbara Yawn, MD, MSc, and colleagues at the Olmstead Medical Center in Rochester, MN, surveyed 426 primary care providers at 3 different medical meetings in 2013 and 2014. The survey asked questions about perceived barriers to diagnosis of COPD and beliefs concerning the value of available COPD medications. The findings were published in the August 2016 issue of the Journal of the COPD Foundation (volume 3; pages 628-635). Results: Of the 426 people who answered the questions on the survey, there were 278 medical doctors (MDs) and doctors of osteopathic medicine (DOs) and 148 nurse practioners (NPs) and physician assistants (PAs).  The two most common barriers to making a diagnosis of COPD were: ♦ patients had many chronic medical conditions, not just COPD; and ♦ patients often failed to recognize and report breathing difficulty. These barriers were similar between MDs/DOs and NPs/PAs.
Woman performing breathing test.

Woman performing breathing test (spirometry).

About one-half of the clinicians said that they had equipment (spirometry) in their office, but less than 2/3 reported using testing to diagnose COPD. Only 10% of those answering the survey reported ordering blood tests (screening) for alpha-1 antitrypsin deficieny, a hereditary form of emphysema. About 75% said that there were available treatments to reduce shortness of breath, and 85% answered that medications for COPD could reduce exacerbations (flare-ups) of COPD. Some of these medications are shown below.
Examples of dry-powder inhalers

Examples of dry-powder inhalers

Conclusions: Primary care providers continue to report multiple barriers to diagnose COPD including easy access to testing equipment. However, most respondents noted that effective medications were available to improve breathing difficulty and to reduce the risk of a flare-up. My Comments: In the past, many primary care providers felt that diagnosing those with COPD was not important because: COPD was self-inflicted by smoking; and treatments for COPD were not generally effective. This survey shows that knowledge and attitudes among primary care providers have changed. Primary care providers do not need to have testing equipment (spirometers) in their offices, but instead can refer patients for testing at the local hospital. If you have told that you have COPD and have not had breathing tests, ask your health care provider to order testing. Ask about what treatments are available to “make it easier to breathe.” BE PROACTIVE. 

Donald A. Mahler, M.D. is Emeritus Professor of Medicine at Geisel School of Medicine at Dartmouth in Hanover, New Hampshire. He works as a pulmonary physician at Valley Regional Hospital in Claremont, NH, where he is Director of Respiratory Services.