COPD: Tips on Primary Care Management

This transcript has been edited for clarity.

Matthew F. Watto, MD: Welcome back to The Curbsiders. I'm Dr Matthew Watto, here with my great friend, Dr Paul Nelson Williams, who I should mention is America's primary care physician.

We're going to talk about COPD in older adults. We had two great guests on this podcast. We learned that as people get older, their lungs get older as well. And on balance, that means the thoracic cage has some changes. There is less elastic recoil and the respiratory muscles don't work as well. In most people that ends up looking like a more obstructive pattern if you were to get spirometry. But Paul, does that mean that we can diagnose every older adult with COPD just because they have abnormal spirometry?

Paul N. Williams, MD: I feel like we probably shouldn't. We get very tied up in the FEV₁/FEV < 0.7 in making the diagnosis, and once you're there, everything else falls by the wayside. But Dr Witt in particular talked about how you need symptoms consistent with the history and the exposure. You asked about COPD-asthma overlap syndrome, and she talked about getting a childhood history. So when you're dealing with presumed COPD, a lot of times it's one of those anecdotal diagnoses that hangs on forever without the diagnosis actually having been formally made. Getting a good history, making sure you're doing your due diligence, and doing the basics can go a long way.