COPD Education

The Early Recognition and
Management of Chronic Obstructive Pulmonary Disease



Definitions and Pathogenesis

The National
Lung Health Education Program

of Smoking Cessation

Management of Symptomatic COPD

of Advanced Disease

New Era




The National Lung Health Education

The Lung Health Study is the scientific foundation for the NLHEP. In
the Lung Health Study, patients who were successful in stopping smoking
had a significant improvement in airflow, followed by a slight decline
over five years, compared with those who continued to smoke. Continuing
smokers had a much more rapid rate of decline of FEV1. The most
common cause of death in the Lung Health Study was not COPD or even heart
attack or stroke. It was lung cancer! Thus, spirometric abnormalities are
indicative of excess risk for the four most common causes of death in the
United States: heart attack, stroke, lung cancer and COPD. The National
Lung Health Education Program (see web site has the mission
to develop a program to reduce the impact of COPD and related disorders
through education of primary care physicians and public awareness. Another
NLHEP mission is to detect COPD and related disorders early in order to
reduce costly illnesses (that impact the quality of life) and to minimize
premature death from COPD and other diseases.

Pulmonologists should support the NLHEP, because they don’t see
patients with early stage disease in the first place. It is the right
thing to do; they need to work in concert with their colleagues in primary
care. Industry should also support the NLHEP, because it will identify
patients in need of pharmacological therapy well before advanced and
complex disease processes ensue. Managed care organizations (i.e., HMOs,
PPOs, etc.) should also support the NLHEP because the prevention of
premature morbidity and mortality due to COPD will ultimately result in a
cost savings to them.

We have a powerful armamentarium for the early identification and
treatment of COPD. This includes the office spirometer, nicotine
withdrawal products, bronchodilators, antibiotics and corticosteroids.

The future challenges for the NLHEP are to implement its concepts and
programs at the grass roots level, to promote smoking cessation programs,
and to develop systematic therapy plans to stop the progression of the
disease. A growing number of pharmacological agents have been released (or
are soon to be released) that will probably alter the course and prognosis
of COPD.


The first essential step in treatment is smoking cessation. This is
covered in Section C. The use of influenza vaccine each fall and
pneumonococcal vaccine at appropriate intervals will also help prevent
these two devastating infections in the majority of individuals.

Simple office spirometers with great accuracy are now available at low
cost. The NLHEP recommends spirometric testing of all smokers (current and
former) age 45 or older and anyone of any age with dyspnea on exertion,
chronic cough, mucus hypersecretion or wheeze. Reimbursement is
established for office spirometry. Code 94010 is for simple spirometry;
rate of reimbursement is approximately $30. Code 91060 is the code for
spirometry with bronchospasm evaluation, with a reimbursement of
approximately $57. These reimbursement rates can vary from

We hope that this early approach to diagnosis and treatment will add
significantly to your practice.


Anthonisen NR, Connett JE, Kiley JP, et al:
Effects of smoking intervention and the use of an inhaled anticholinergic
bronchodilator on the rate of decline of FEV1. The Lung Health
Study.  JAMA 1994;272:1497-1505. Results of the Lung Health Study.
Lung function improvement in sustained cigarette abstinence compared with
decline in continued smokers. Most common cause of death at 5 years was
lung cancer!

Barnes PJ: Chronic obstructive pulmonary
disease. N Engl J Med 2000;343:269-280. A comprehensive review of
pathogenesis and treatment of COPD including novel future therapies.

Birring SS, Brightling CE, Bradding G, et
al: Clinical, radiologic, and induced sputum features of chronic
obstructive pulmonary disease in non-smokers: a descriptive study. Am J
Respir Crit Care Med 2002;166:1078-1083. Evidence of increased sputum
neutrophilia in smokers with COPD compared with non-smokers.

Ferguson GT, Enright PL, Buist AS, et al:
Office spirometry for lung health assessment in adults: a consensus
statement from the National Lung Health Education Program. Chest
2000;117:1146-1161. Recommends spirometric testing in all current and
former smokers age 45 and older and in anyone with dyspnea on exertion,
chronic cough, mucus hypersecretion or wheeze.

Morris JF, Temple W: Spirometric “lung age”
estimation for motivating smoking cessation. Prev Med 1985;14:655-662.
Normal lung age is that age at which a person’s measurement of
FEV1is normal.

National Heart Lung & Blood Institute
Data Fact Sheet USDHS – May 2001. The most recent statistics from the

Schoh RJ, Fero LJ, Shapiro H, et al:
Performance of a new screening spirometer at a community health fair.
Respir Care 2002;47:1150-1157. A new ultrasonic spirometry had
equivalent performance compared with a standard laboratory spirometer.

Silverman EK, Speizer FE: Risk factors for
the development of chronic pulmonary disease. Med Clin North Am