Chronic obstructive pulmonary disease (COPD) increasingly is viewed by clinicians as a systemic disease that is treatable, instead of a debilitating lung disease that offers few options for patients. To drive that point home, the VA and DoD recently updated their joint clinical practice guideline for the first time in more than seven years.
By Sandra Basu
WASHINGTON — With the care and management of chronic obstructive pulmonary disease (COPD) changing significantly over the last few years with advances in research and treatment options, the VA/DoD’s clinical practice guidelines (CPG) for the diagnosis and management of COPD underwent a makeover at the end of last year. The update is the first one for the CPG since 2007.
“The general theme was to try to drive home the point that COPD is not just a lung disease but more of a systemic disease that is very treatable. That was in the previous guideline, but that is still a relatively new concept for a lot of people,” said Army Lt. Col. John Sherner, MD, program director of the National Capital
Consortium’s pulmonary and critical care medicine fellowship at Walter Reed
National Military Medical Center, told U.S. Medicine. A staff physician in the pulmonary and
critical medicine department at Fort Belvoir Community Hospital in Virginia, Sherner also served as a COPD Guideline Work Group co-chair from DoD.
The effort to update the CPG was a particularly important task, given the impact of COPD. It is a major health problem worldwide, and veterans are at higher risk of COPD than the general U.S. population.
Within VA, COPD is about four times more prevalent than in the general population, largely because of tobacco exposure and the high rate of current and past tobacco use.
Although the VA already treats about 1 million COPD patients, that number is expected to increase. A report from the House Committee on Veterans’ Affairs estimated that prevalence of airflow limitation is 33%-43% among VHA patients, indicating even higher rates of undiagnosed disease.
Marta Render, MD, who served as a co-chair of the work group from VA, pointed out that under-diagnosis or a late diagnosis in veterans is a challenge.
“The problem with that is the most effective strategy is prevention, which means early on quit smoking,” said Render, director of the VHA National Program Director for Pulmonary, Critical Care and Sleep.
One way VA has been working to improve diagnosis is by offering spirometry testing in community-based outpatient clinics so patients do not have to always travel to a VAMC to be screened.
“They can get it in the clinics, and we think that will help in the diagnosis,” Render told U.S. Medicine.
While implantable devices have shown promise in reducing rehospitalization for heart failure (HF), VA researchers sought to determine if options that are less expensive and non-invasive would have comparable results.
Legislation to prevent VA from outsourcing creation of its drug formulary and to require more input from medical professions is being considered in Congress.