Role of primary care in early diagnosis and effective management of COPD.

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is a common multi-component disease that imposes an enormous burden on the patient, the healthcare professional and the society in terms of morbidity, mortality, healthcare resource utilisation and cost. Despite the availability of several comprehensive treatment guidelines, COPD is both under-diagnosed and misdiagnosed. Some of the factors contributing to this are a poor knowledge and low adherence to guideline recommendations, on the part of some healthcare professionals, and a lack of understanding of the significance and severity of the disease, on the part of patients. However, evidence suggests that COPD is both preventable and treatable when it is diagnosed early and treated effectively. Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines suggest that the key to early diagnosis is the recognition of the clinical features of persistent cough, chronic sputum production, breathlessness on exertion and a history of exposure to tobacco smoke. Primary care clinicians can play a crucial role in early diagnosis of at-risk subjects. They can educate patients to recognise the early symptoms of COPD, avoid the risk factors, such as smoking, and encourage early presentation to a primary care professional. Similarly, evidence suggests that effective implementation of non-pharmacological and pharmacological interventions can improve the management of COPD patients at the primary care level.
OBJECTIVES: The aim of this review is to discuss the role of the primary care team in the early diagnosis and effective management of COPD, and to outline education initiatives and management strategies that can be implemented in primary care.