Test your knowledge of the latest developments in a complicated and rapidly changing area of patient care.
Diagnosis and treatment of patients with chronic obstructive pulmonary disease (COPD) is changing rapidly, so understanding recent advances is essential to delivering optimal patient care, according to the authors of a review published in JAMA earlier this year.
To help primary care physicians (PCPs) address the highly variable clinical features and responses to therapy, they provided a wealth of practical information on the diagnosis and long-term management of patients with COPD in the outpatient setting.
Take this brief quiz on their findings to see how much you know about COPD diagnosis.
1. Who currently makes the majority of COPD diagnoses?
C. Respiratory therapists
Answer: B. PCPs. PCPs make the diagnosis for most patients with COPD and manage patient care for ~80% of the roughly 30 million adults in the US known to have the condition. COPD accounts for 3.2% of physician office visits annually and is the fourth leading cause of death (126 000 deaths/year) in the US. Approximately 6% of the US population self-reports a diagnosis.
2. Which factor accounts for most COPD diagnoses?
A. Tobacco smoke
B. Occupational dusts and chemicals
C. Environmental particles
D. Gas exposures
Answer: A. Tobacco smoke. More than 75% of COPD diagnoses in the US are related to tobacco smoke. Implicated in ~25% of patients with COPD who never smoked, are smoke from wood and other fuels used for cooking and heating as well as occupational dust and chemical fume exposures. Premature birth, severe childhood respiratory infections, and poorly controlled asthma are associated with lower peak adult lung function, which increases the odds of COPD after exposure by >12-fold.
3. Which tool is recommended for stratifying and monitoring COPD progression?
A. COPD and Breathing
B. COPD Airway Detection
C. COPD Action Plan
D. COPD Assessment Test (CAT)
Answer: D. COPD Assessment Test (CAT). An 8-question, 0- to 40-point symptom scale, the CAT assesses cough frequency, phlegm amount, chest tightness, tolerance to hill or stair climbing, home activity level, confidence leaving home, sleep soundness, and energy level. Another recommended assessment tool-the modified Medical Research Council (mMRC) dyspnea scale-stratifies severity of dyspnea in respiratory diseases, particularly COPD.
4. What is the reference standard for diagnosing and assessing COPD severity?
A. Chest X-ray
B. CT scan
D. Arterial blood gas test
Answer: C. Spirometry. If obstruction is present on spirometry, review authors recommended administrating a short-acting bronchodilator and to retest the patient in 15 minutes to establish the diagnosis of incompletely reversible obstruction (the hallmark of COPD). The Global Initiative for Chronic Obstructive Lung Disease guidelines recommend using a fixed ratio of 0.7 of the forced expiratory volume in the first second of the forced vital capacity (FEV1/FVC) to establish a diagnosis of obstruction.
5. Physical examination may be used to assess signs of lung hyperinflation in advanced COPD.
Answer: A. True. Physical examination also may help rule out alternative diagnoses related to nonpulmonary organ involvement. Adventitious breath sounds (eg, wheezing and rhonchi) may indicate an acute exacerbation rather than stable COPD. Rales may suggest pulmonary fibrosis or congestive heart failure. Auscultation of prolonged air flow at the trachea during a maximal forced effort may be useful in early diagnosis of obstruction or when spirometry is not available.
6. Which tool(s) may be used to predict mortality risk in patients with COPD?
A. Assessment of Burden of COPD scale
B. COPD Checklist
C. Age, dyspnea, airflow obstruction (ADO) & body mass, obstruction, dyspnea, exercise (BODE) indexes
D. Oxygen cost diagram
Answer: C. ADO and BODE indexes. The ADO index predicts risk of mortality by incorporating age, mMRC dyspnea scale, and FEV1, which are easily accessible measures in a primary care setting. The BODE index predicts mortality by incorporating the negative prognostic implications of a body mass index of ≤21, FEV1, mMRC, and the 6-minute walk test. Assessing risk of future acute exacerbations and death helps in setting patient expectations and planning treatment.
STAY TUNED: Part 2 of this quiz will focus on treatment of patients with COPD in the primary care setting.