COPD is defined as a “common preventable and treatable disease, characterized by airflow limitation that is usually progressive and associated with an enhanced chronic inflammatory response in the airways and the lung to noxious particles or gases. Exacerbations and comorbidities contribute to the overall severity in patients.” This definition comes from the 2016 Global Initiative for Chronic Obstructive Pulmonary Disease (GOLD) guidelines. To make a formal diagnosis of COPD, providers must perform spirometry. A postbronchodilator FEV1/FVC < 70% is consistent with a diagnosis of COPD. Spirometry classifications are then broken down by the patient’s FEV1.
Smoking remains the most common cause of COPD and it remains highly relevant despite the recent decrease in tobacco use in the United States. COPD remains the third leading cause of death. Very few interventions decrease mortality for chronic COPD: smoking cessation and oxygen. Despite this, the drug market has exploded with new treatments for COPD over the past five years. Physicians are inundated with inhaler acronyms: SABA, SAMA, LAMA, LABA, ICS and combinations of the above. How are physicians to know which medications should be utilized and in what sequence?
Beginning in 2011 with the release of the updated GOLD guidelines and the American Thoracic Society (ATS) guidelines, the evaluation of COPD patients changed dramatically. Instead of picking an inhaler or combination of inhalers based on spirometry alone, the new guidelines combined validated patient questionnaires, spirometry and COPD exacerbation frequency to paint a broader picture of COPD patients. This assessment although, marketed as more patient centered, was complicated and required more data collection and synthesis at the point of care. The 2016 GOLD guidelines continue to recommend this assessment using either the COPD Assessment Test (CAT) or the modified Medical Research Council Scale (mMRC) to perform this assessment. These are much shorter questionnaires than the most commonly used research questionnaire, the St George’s Respiratory Questionnaire (SGRQ). Interestingly, the CAT is owned by Big Pharma: GlaxoSmithKline, and can only be accessed via their website or the new COPD Pocket Consultant app. The mMRC can be found on the medical calculator app, MedCalx.
Evidence based medicine
The app includes the two most recommended COPD patient assessment questionnaires, COPD Assessment Test (CAT) and the mMRC, in app form along with a full patient assessment that includes spirometry and COPD exacerbations. This full assessment is the current recommended method for determining which medications should be prescribed to COPD patients by the 2016 GOLD and 2011 ATS/ACP COPD guidelines. Unfortunately, the CAT is literally owned by GlaxoSmithKline and this is likely why it is only available via this app which is sponsored by Big Pharma and the COPD Foundation.
Who would benefit from this App?
Any healthcare provider who cares for COPD patients including students, NP’s, PA’s, Family Medicine, Internal Medicine, Pulmonologists, and Geriatricians.
Disclaimer: The views expressed are those of the author(s) and do not reflect the official policy of the Department of the Army, the Department of Defense or the U.S. Government.
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