Identifying chronic obstructive pulmonary disease in primary care of urban underserved patients: tools, applications, and challenges.

Among urban low-income and minority patients with compromised access or low adherence to primary care, exacerbations of unrecognized but symptomatic moderate to severe chronic obstructive pulmonary disease (COPD) cause avoidable emergency room visits and hospitalizations. Detection and management of COPD before a first exacerbation reduces morbidity and disability, forestalls cardiorespiratory complications, improves health-related quality of life, and reduces health care costs. However, current efforts in ascertainment and care of COPD have insufficiently improved outcomes in underserved groups. Effective COPD care requires access to detection and management resources: screening tools to identify who may have COPD, spirometric diagnosis, smoking cessation assistance, vaccinations, stage-appropriate pharmacotherapy, and rehabilitation. This article describes recent advances in tools suitable for assisting COPD identification in primary care practices and discusses their applications in urban underserved populations. The validated COPD Population Screener is readily understood by patients, self-scored, available online (www.copdscreener.com), and usable in community outreach as well as primary care settings. Symptom-based risk stratification with a validated questionnaire provides a rational trigger targeting limited spirometry resources to patients most likely to have COPD. Case finding is the first step of COPD management to reduce its individual and public health burden.