Blue Care Network Best Practices
Waterford practice uses spirometry to diagnose COPD and asthma
Joel Leib, D.O., of Waterford Medical Associates, believes that spirometry is an important diagnostic tool for patients with chronic obstructive pulmonary disease. He uses spirometry to diagnose patients and to track their progress in planning for follow-up care.
With COPD diagnosis, the biggest risk factor is a history of smoking. "If the patient has a history of smoking, I will do a spirometry test because the patient may be used to being short of breath and may not even realize they have COPD," says Dr. Leib. If the patient has been smoking for a long time, Dr. Leib does a spirometry test, even if the patient is relatively young.
"I can enter the age of a patient and show the relative age of their lungs, and that sometimes has an impact on the patient and may motivate them to quit smoking," says Dr. Leib.
COPD in its early stages may have few symptoms, so a confirmation of a diagnosis through spirometry can mean treatment starts in the early stage of the disease.
Even though the HEDIS® measure specifically pertains to COPD, the spirometer is a good tool for diagnosing and treating asthma patients as well, says Dr. Leib.
After taking a history to see how often the patient's asthma is an issue, Dr. Leib takes a baseline spirometry measure.
"They may not realize their FEV is very low," says Dr. Leib. "The patient may need a steroid besides an inhaler. I will treat and wait a month and see if it changes."
Dr. Leib says he has worked with pulmonologists who say testing with spirometry is one of the best things a primary care doctor can do. "Our nurses are well trained and the spirometer is computerized. The nurses do the testing, which takes 15 minutes. Then I interpret the results before I meet with the patient," says Dr. Leib.
Dr. Leib's office monitors the patients when they come in for routine visits. Nurses check charts when the appointment is scheduled. For patients already diagnosed with COPD or asthma, the nurses check to see when their last spirometry test was done.
When Dr. Leib diagnoses a patient with COPD, he usually starts the patient with a bronchodilator called salmeterol (Serevent®) or an anticholinergic like Spiriva®.
"Sometimes I'll add on an inhaled steroid or Advair®, which is a combination steroid and long-acting dilator," says Dr. Leib. "If the patient is doing well, I will do a re-check in several months."
Dr. Leib emphasizes the importance of recommending that COPD patients get their flu and pneumonia vaccines. "These patients are more susceptible to pneumonia and bronchitis," he says.
In Dr. Leib's practice, follow-up for COPD patients is important. "If someone comes in and has an exacerbation, I will wait a period of time after treatment and check them again," says Dr. Leib. "It's important to have a graph on their progression or decline. It's also important to know if the patient continues to smoke or has an infection. You have to continually stay on top if it," he adds.