Dr Albert Rizzo Outlines Prevalence of Overtreatment, Undertreatment in COPD

Albert Rizzo, MD, FACP, chief medical officer for the American Lung Association, discusses the prevalence of overtreatment and undertreatment in chronic obstructive pulmonary disease (COPD).

Transcript

How prevalent is overtreatment in COPD? Are there identified ways to mitigate this?

I think the main reason some overtreatment may occur is when the symptom of shortness of breath is thought to be COPD and it’s not. Certainly, very often, cardiac disease can make an individual short of breath and it’s not always clear cut whether it’s heart or lungs causing the problem. It’s been, over the years, the pulmonologists say it’s the heart, the heart doctors will say it’s the lungs, so it can be both. Comorbidities exist in COPD. But overtreatment can include giving the patient of the drugs.

Maybe an individual does not need an inhaled steroid, all they need is the bronchodilators. That would be an individual who has symptoms but really has not had risk of exacerbation. So, overtreatment with inhaled corticosteroids could be a concern if that happens. It’s hard to quantify how much that’s happened over the years because there’s been a little change in the guidelines as to the role of inhaled corticosteroids and when’s the proper time to institute them.

But in general, COPD has probably been a bit undertreated over the years. Initially it started out at giving them 1 maybe short-acting bronchodilator they would use intermittently. If you think about the C in COPD, it stands for chronic. It means there’s always airflow obstruction. So, a patient diagnosed with COPD needs bronchodilation on an ongoing basis most of the time. We now know that bronchodilatation can be maximized by using 2 pathways: long-acting beta agonists and the long-acting antimuscarinic. So many individuals now would say that the first diagnosis of COPD may mean an individual be put on a dual bronchodilator, and I think a lot of people are still on either single or intermittent use of bronchodilators and I would think that’s an undertreatment.