Overview
Sponsored by the American College of Chest Physicians.
Supported by an educational grant from AstraZeneca LP.

Program Description
The use of spirometry for the early detection of COPD has become a topic of controversy since 1999, when CHEST published the National Lung Health Education Program (NLHEP) guidelines recommending office spirometry testing for all smokers over the age of 45 years. The benefits of drug therapy when the FEV1 is above 50% predicted are disputed, while only one in four patients with a new diagnosis of COPD has undergone spirometry testing to confirm any degree of airway obstruction. Two members of NLHEP will discuss the evidence for and against large national programs that provide screening or promote case-finding for COPD.

In this web-based format, participants have the opportunity to obtain the information as it was originally presented by watching the video slide presentations on line, downloading the slides for review, or downloading a written executive summary of the presentations to read. Following their review of the presentations, participants will be asked relevant test questions as part of the evaluation process to obtain CME credit.

Educational Objectives

• Understand the options that can be used by clinicians in the early detection of COPD.
• Identify strategies to improve the rates of detection and confirmation of COPD in primary care settings.
• Consider narrowing the focus to confirm COPD before inhalers are prescribed.

Target Audience
Advanced Practice Nurses, Cardiologists, Critical Care Physicians, Fellows in Training, General Medicine Physicians, Physician Assistants, Pulmonary Physicians, and Registered Nurses.

Needs Assessment
Chronic obstructive pulmonary disease is a major health problem in the United States. More than 12 million people have been diagnosed with COPD, and another 12 million have signs of the disease but have not yet been diagnosed.¹

Despite the ease of screening and diagnosis, COPD remains an underdiagnosed disease, chiefly in its earlier, milder, and more treatable form. Studies have shown that COPD is underrecognized and, in many instances, undertreated. According to an analysis² of health-care delivery in communities with more than 200,000 people, 58.9% of patients with COPD receive recommended care, with wide variation across communities. 

Early diagnosis and effective treatment in the milder stages of COPD are vital in preventing complications and worsening of symptoms over time. Although spirometry is the most accurate method to confirm the diagnosis of COPD and establish the treatment plan, two-thirds of patients at risk for COPD do not receive a spirometry exam.³ Yet, there have been observations that spirometry has also been used inappropriately, including overuse and failing to use a pos bronchodilator FEV1 in the diagnosis.⁴ This issue has stirred controversy, and it has importance for public health programs and recommendations for clinicians. The topic was addressed by the proposed pro/con session at CHEST 2008.

COPD is important to the members of the ACCP, as most members treat these diseases every day. The ACCP has included COPD in the core curriculum that is being developed to guide the ACCP in its educational offerings. Moreover, the ACCP CHEST 2008 Program Committee named COPD as one of the key topics to be covered at the CHEST 2008 annual meeting.

References

1. 1. National Heart, Lung and Blood Institute. COPD: Learn More, Breathe Better. Learn About COPD.org. Accessed April 20, 2009
2. 2. Mularski RA, Asch SM, Shrank WH, et al. The quality of obstructive lung disease care for adults in the United States as measured by adherenece to recommended processes. Chest 2006; 130:1844-1850
3. 3. Han MK, Kim MG, Mardon R, et al. Spirometry utilization for COPD. Chest 2007; 132:403-409
4. 4. Enright P, Quanje P. Spirometry for COPD is both underutilized and overutilized. Chest 2007; 132:368-370

Faculty
Barry J. Make, MD, FCCP
Co-Director, COPD Program
Director, Pulmonary Rehabilitation and Respiratory Care
National Jewish Health
Professor of Medicine
Division of Pulmonary Sciences and Critical Care Medicine
University of Colorado School of Medicine
Denver, CO

Brian W. Carlin, MD, FCCP
Allegheny General Hospital
Pittsburgh, PA

Paul L. Enright, MD
Professor of Medicine
University of Arizona
Tucson, AZ

CME & Disclaimers

Release: May 2009
CME Expiration: June 30, 2010
Estimated completion time: 2 hours
This CME product is a Web-based activity.
Participants will watch and listen to a Webcast slide presentation and complete an activity evaluation to obtain CME.

Accreditation/Designation
The American College of Chest Physicians is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

The American College of Chest Physicians designates this educational activity for a maximum of 2 AMA PRA Category 1 Credits^TM. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Anyone who attended the Early Detection of COPD: A Clinical Controversy morning symposium session at CHEST 2008 when this content was originally presented, and already claimed CME for this presentation, cannot claim CME from this enduring product.

Disclosure Statement
The ACCP remains strongly committed to providing the best available evidence-based clinical information to participants of this educational activity and requires an open disclosure of any potential conflict of interest identified by our faculty members. It is not the intent of the ACCP to eliminate all situations of potential conflict of interest, but rather to enable those who are working with the ACCP to recognize situations that may be subject to question by others. All disclosed conflicts of interest are reviewed by the educational activity course director/chair, the Education Committee, or the Conflict of Interest Review Committee to ensure that such situations are properly evaluated and, if necessary, resolved. The ACCP educational standards pertaining to conflict of interest are intended to maintain the professional autonomy of the clinical experts inherent in promoting a balanced presentation of science. Through our review process, all ACCP CME activities are ensured of independent, objective, scientifically balanced presentations of information. Disclosure of any or no relationships will be made available on-site during all educational activities.

The following faculty members of this educational activity have disclosed to the ACCP that a relationship does exist with the respective company/organization as it relates to their presentation of material and should be communicated to the participants of this educational activity:

Paul L. Enright, MD
Consultant fee, speaker bureau, advisory committee, etc.: Consulting for the spirometry quality assurance program for a 3-year clinical trial of varenicline for smoking cessation, funded by Pfizer. Total consulting fees for this project will be less than $15,000.

Barry J. Make, MD, FCCP
University grant monies: GSK, Pfizer, Boehringer-Ingelheim, Forest, Schering, Dey, Spiration, Chiesi, Broncus, AstraZeneca, Novartis, Aeris

Grant monies (from sources other than industry): National Heart, Lung, and Blood Institute

  Grant monies (from industry related sources): GSK, Boehringer-Ingelheim, Pfizer

  Consultant fee, speaker bureau, advisory committee, etc.: Speaker Bureau: GSK, Pfizer, Boehringer-Ingelheim

Advisory Committee: GSK, Pfizer, Boehringer-Ingelheim, Forest, Schering, Dey, Spiration, Chiesi, Broncus, AstraZeneca, Novartis

  Product/procedure/technique that is considered research and is NOT yet approved for any purpose.
Bronchoscopic lung volume reduction surgery, inhaled steroids effect on patient-reported outcome, macrolides to prevent COPD exacerbations, inhaled bronchodilators to prevent exacerbations of COPD

The following faculty member of this educational activity have indicated to the ACCP that no potential conflict of interest exists with any respective company/organization:

Brian W. Carlin, MD, FCCP

Disclaimer
The American College of Chest Physicians ("ACCP") and its officers, regents, executive committee members, members, related entities, employees, representatives and other agents (collectively, "ACCP Parties") are not responsible in any capacity for, do not warrant and expressly disclaim all liability for, any content whatsoever in any ACCP publication or other product (in any medium) and the use or reliance on any such content, all such responsibility being solely that of the authors or the advertisers, as the case may be. By way of example, without limiting the foregoing, this disclaimer of liability applies to the accuracy, completeness, effectiveness, quality, appearance, ideas, or products, as the case may be, of or resulting from any statements, references, articles, positions, claimed diagnosis, claimed possible treatments, services, or advertising, express or implied, contained in any ACCP publication or other product. Furthermore, the content should not be considered medical advice and is not intended to replace consultation with a qualified medical professional. Under no circumstances, including negligence, shall any of the ACCP Parties be liable for any DIRECT, INDIRECT, INCIDENTAL, SPECIAL or CONSEQUENTIAL DAMAGES, or LOST PROFITS that result from any of the foregoing, regardless of legal theory and whether or not claimant was advised of the possibility of such damages.

CME Instructions
CME for this activity is available through June 30, 2010. To receive CME credit and print your certificate, complete an online evaluation by doing the following:

1. Go to www.chestnet.org, and click on the "CME Certificates" icon.
   
   
2. Log in using your ACCP ID number or e-mail address on file with the ACCP. Enter your ACCP ID number and click submit, OR, if you do not have an ACCP ID number, click on the link, "Create an account here."
   
   
3. To locate the product for which you want to claim CME credit, look under the "Available CME" tab on the left navigation bar.
   
   
4. Click the "Claim Credit" link next to the product to begin the certificate process.
   
   
5. Complete any required posttest and evaluation. Please be sure to check the box that states you are finished with the evaluation.
   
   
6. Once you submit the evaluation, your CME certificate will be created and will show under the tab, "My CME History." You can print it at any time by clicking the "Certificate" link.

If you need help, please contact the CME Administrator via e-mail at CME@chestnet.org, or leave a voice mail message at (847) 498-8376. For faster assistance, please outline the specific problem you are having, and provide your ACCP ID and contact information.

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