"Be Vigilant About Risk Factors for COPD, Aggressive with Questions About Symptoms," Expert Advises Primary Care

"I wish we had one definitive tool to recommend, but for now, it’s about clinicians staying vigilant about risk factors..."

MeiLan Han, MD, MS, replied to a query about challenges faced by primary care clinicians when it comes to screening for COPD in clinical settings. In a recent interview with Patient Care, Han, professor of internal medicine and chief of the division of pulmonary and critical care medicine at the University of Michigan Health, in Ann Arbor, MI, lamented the lack of a "one-and-done" assessment that would leave no question about the presence of the obstructive lung disease but stressed that in its place, primary care professionals need to be "vigilant" about considering and understanding a patient's risk factors as well as "aggressive" about asking patients about symptoms.

In the short video segment above, she also emphasized the overlap in the populations that should be screened for lung cancer and COPD, pointing out that the dual focus could improve outcomes in both diseases.

The following transcript of the conversation has been lightly edited for clarity and style.

Patient Care: How would you describe the greatest challenges to timely and effective screening for COPD in primary care?

MeiLan Han, MD, MS: One of the challenges we face is the lack of a single, universally recognized screening tool for COPD approved by a major agency. The US Preventive Services Task Force, for instance, advises against routine screening for COPD in the general population. However, that recommendation doesn’t apply to high-risk groups.

I wish we had one definitive tool to recommend, but for now, it’s about clinicians staying vigilant about risk factors—primarily tobacco use, but also others like low birth weight, exposure to secondhand smoke during childhood, or working in environments with significant dust or pollutants. Any of these could increase risk for COPD.

Clinicians also need to ask more detailed questions about symptoms. Patients often adjust their behavior to avoid discomfort, so they might say they’re not short of breath but have stopped routine activities, like walking. It’s crucial to probe deeper about activity levels. We also need to have a low threshold for performing spirometry when there’s any suspicion of COPD.

We are actually considering stronger recommendations for more routine spirometry. One reason for that is the difficulty of interpreting a single measurement in time. A patient might come into the clinic sick but the spirometry results are “normal.” Without a baseline measurement from earlier in life, we can’t tell if that normal is actually a significant decline from their usual and that it should be cause for us to worry. This uncertainty highlights the value of early baseline spirometry.

The GOLD initiative has increased the discussion around "pre-COPD"—a phase where patients may not meet spirometry criteria for COPD but still show symptoms, exacerbations, or imaging abnormalities. While we don’t fully understand how to treat this group yet because we are still studying them, risk factor modification is even more important for patients showing early signs of disease.

PC: New data show that screening for lung cancer in the US is extremely low. What are the connections between screening for lung cancer and for COPD?

Han: One of the most important areas we need to think about is lung cancer screening. Primary care is already familiar with lung cancer screening guidelines—and that is the same population that should raise suspicion for COPD. For instance, if you have a patient over the age of 50 with a 20-pack-year smoking history and you’re thinking it’s time to get them into a lung cancer screening program, think also about getting a spirometry reading on this patient. The data suggest that a significant portion of these patients, between a third and a half, also have COPD. Conversely, if a patient has COPD, don’t overlook the need for lung cancer screening.

CT scans used for lung cancer screening can reveal abnormalities like emphysema, which should prompt further testing for COPD. Even without spirometry, these findings can guide the next steps in managing the patient. This dual-focus approach could improve outcomes for both conditions.

MeiLan K Han, MD, MS, is professor of internal medicine and chief of the division of pulmonary and critical care medicine at the University of Michigan Health, in Ann Arbor, MI. Han's research focus is on defining phenotypes in COPD using imaging. She is a lead investigator for several NIH sponsored COPD studies and serves as a spokesperson for the American Lung Association and board member of the COPD Foundation. She is currently a deputy editor for the American Journal of Respiratory and Critical Care Medicine and serves as a member of the GOLD scientific committee, responsible for developing the internationally recognized consensus statement on COPD diagnosis and management.