Raising Awareness of COPD: A Call to Action by the Readers of COPD

Journal of COPD readers no doubt appreciate the burden of Chronic Obstructive Pulmonary Disease. Population-based survey data from the 1991–1994 National Health and Nutrition Examination Survey (NHANES) estimated there were 24 million adults with diminished lung function in the United States, but less than half of these (10 million, or 42%) reported a physician diagnosis of COPD ([1]). Subsequent research has chronicled the worldwide burden of COPD, including disease prevalence, costs, and mortality ([2], [3]). These studies demonstrate that COPD is increasing in epidemic proportions in developed and developing countries due to decades'-long increase in tobacco smoking, accompanied by unacceptably high rates of under-diagnosis and under-treatment ([4], [5], [6]). It is currently the 4th leading cause of death in the U.S., projected to become the 3rd leading cause by 2020, and more women than men now die of COPD in the U.S. ([1]). The impact of COPD on patients has also been recognized ([1], [7]). Patients with COPD are twice as likely to report limitation in physical activity compared to people without COPD ([1]). Despite increasing awareness in the medical community of the burden and impact of COPD, these messages have not been conveyed to patients at highest risk for the disease—men and women with a history of smoking. Additionally, the dual messages of the need to diagnose and institute effective prevention and treatment of COPD has not been effectively communicated to physicians treating these patients.

The National Heart, Lung, and Blood Institute (NHLBI) launched a national campaign to raise awareness of the public about COPD in January 2007. The goal of the campaign is to “brand” COPD. Surveys of public attitudes and knowledge about COPD were conducted by a nationally recognized public relations firm with experience in awareness campaigns involving other chronic medical disorders. Survey findings characterized lack of awareness about COPD and confirmed the need for a national education program. Not surprisingly, these surveys indicated that smokers were cognizant of the need to cease tobacco use, but they did not want to be reminded about tobacco cessation. With input from patients, physicians, and testing among those at risk for COPD, the NHLBI set its objective: raise awareness of COPD among adults over age 40 with a history of smoking, and encourage them to see their health care providers for a simple breathing test.

Campaign materials include radio and print public service announcements, fact sheets for those at risk and those diagnosed with the disease, as well as a guide for health care professionals. A web site with patient and physician information has also been launched: www.learnaboutcopd.org. Successful implementation of the campaign depends upon the effectiveness of gaining wide distribution and adoption of the materials and placing them in front of the public. Local communities have a key role in assuring placement of these materials.

If the NHLBI COPD Awareness and Education Campaign successfully leads patients to the offices of their primary care practitioners, will these practitioners accurately diagnosis COPD in patients with mild disease? Recognition of the burden of COPD and translation of practice guidelines to clinical care have seemingly lagged. Indeed, recent analysis of administrative data from the Veterans Administration Medical System revealed spirometry was only performed in one-third of newly diagnosed COPD patients ([5]). However, the importance of spirometry was confirmed in a recent study of general physicians that demonstrated use of spirometry influenced COPD diagnosis and management ([6]). Likely spurred by relatively recent FDA approval of inhaled medications for COPD, there have been an increased number of educational efforts to assist general health care practitioners to better understand how to diagnose and manage COPD. Whether educational efforts to change physician behavior will result in more widespread appropriate diagnosis and management of COPD with attendant reduction of disease burden is unclear. Given the paucity of longitudinal evaluations of physician knowledge, attitudes, and behaviors about the diagnosis and management of COPD, more research is needed.

Our shared vision is that the NHLBI COPD Public Awareness Campaign will lead to an increase in awareness, a rise in the number of patients accurately diagnosed with COPD, and ultimately improvement in patient outcomes. However, for this vision to be realized, the readers of the Journal of COPD must take an active role in their local community. A call to action for health care professionals is necessary for this campaign to be successful. We urge the readers of COPD to:

• Raise awareness in your community. Collaborate with other health care practitioners including primary care physicians, nurses, and respiratory therapists, people with COPD, and other interested organizations including hospitals, professional societies, and voluntary health care organizations such as the American Lung Association. Seek opportunities to place campaign public service announcements in the media, conduct seminars on COPD for those at risk, and contact local media to encourage news coverage of COPD. Distribute campaign materials locally.

• Develop innovative systems to assure local availability and access to spirometry for patients and primary care practitioners to meet the expected short-term and long-term needs.

• Educate local health care professionals in primary care about the early diagnosis and effective management of patients with COPD using evidence-based clinical practice guidelines ([8], [9]). Education about the role of spirometry as a simple office-based test in the diagnosis of COPD merits particular attention.

This is an exciting time for COPD for both patients and physicians. The science of COPD is rapidly evolving as we learn more about disease pathogenesis, large studies are increasing our understanding of the effectiveness of established therapies, and novel therapeutic targets will lead to new treatments. We hope you will share this excitement with your local community.

The authors wish to thank the staff at the National Heart, Lung, and Blood Institute for their comments and suggestions.