Care By Pulmonologist Leads To Improved Outcomes

Better Quality Of Life And Less Health Care Utilization Compared WIth Usual Care

Background

As many as 70% of persons with COPD do not receive a diagnosis of their condition for various reasons. Not surprisingly, these individuals have worse quality of life, greater health care utilization, and poorer work productivity than healthy individuals of similar age. Because many individuals with COPD have not been diagnosed, their respiratory symptoms remain untreated.

Although it is thought that early diagnosis and early treatment are beneficial, there is no evidence to support this consideration. In addition, whether care provided by a specialist - pulmonologist - compared with a primary care professional is better is uncertain.

Care By Pulmonologist Leads To Improved Outcomes

Study

Dr. Shawn Aaron and colleagues from Ottawa Hospital in Ontario, Canada, used a case-study method to identify adults in the community with respiratory symptoms (shortness of breath, cough, and/or wheezing) without a diagnosis of asthma or COPD. A survey company contacted individuals living within 90-minute driving distance from one of the 17 sites in Canada. Those 18 years of age or older with respiratory symptoms were invited for an in-person visit that included breathing tests (pulmonary function tests). After a diagnosis was made, subjects were assigned by chance to receive care from either their primary care professional OR a pulmonologist and asthma-COPD educator.

The primary outcome was the rate of participant-initiated health care utilization for a respiratory illness over one year.

The study was funded by the Canadian Institutes of Health Research. The study findings were published in the June 13, 2024, issue of the New England Journal of Medicine (volume 390; pages 2061-2063).

Results

Of 38,353 individuals interviewed over the phone, 595 were found to have undiagnosed COPD or asthma after breathing tests. 253 were assinged to care by a pulmonologist and asthma-COPD educator (group called INTERVENTION) and 255 were assigned to care by a primary care professional (group called USUAL CARE). The MAJOR FINDINGS were:

1. The rate of participant-initiated health care utilization for a respiratory illness over one year was lower in the INTERVENTION group (0.53 events) than in the USUAL CARE (1.12 events) group. The incidence rate ratio was 0.48.

Analysis of the primary outcome - paticipant-initiated health care utilization for a respiratory illness - in ALL subjects (overall) and in those with either asthma or COPD. The results shown to the left of the vertical line indicate a better outcome in the INTERVENTION group.

2. At 12 months, the St. George’s Respiratory Questionnaire (measures health-related quality of life) was lower (better) by 10.2 points in the INTERVENTION group compared with 6.8 points in the USUAL CARE group.

3. FEV1 increased by 119 ml in the INTERVENTION group and by 22 ml in the USUAL CARE group (difference = 94 ml).

Conclusions

In those adults living in the community with undiagnosed asthma or COPD, those who received pulmonologist directed treatment had less subsequent health care utilization for a respiratory illness than those who received usual care.

In addition, quality of life and lung function had greater improvements with specialty care compared with primary care.

My Comments

Based on these findings, consider asking your primary care professional for a referral to a pulmonologist if you are not already seeing such a specialist. A one-time consultation may be helpful to confirm the diagnosis and provide recommendations for treatment. Therapy might include the most appropriate inhaled medications, how to use the device(s) correctly, referral to pulmonary rehabilitation, recommendations on flu (influennza), pneumonia, and respiratory synctial virus (RSV) vaccinations, and evaluation for oxygen therapy. Pursed-lip breathing and using the tripod position are also important to alleviate breathing difficulty.

The three steps of pursed-lip breathing that reduces shortness of breath by allowing better emptying of air out of the lungs.