Because most patients with undiagnosed chronic obstructive pulmonary disease (COPD) adjust their lifestyle to address their symptoms, diagnosis occurs much later in disease progression, resulting in escalating costs for treating exacerbations through hospitalizations and emergency department visits.
Managed Healthcare Executive (MHE) asked Christopher Blanchette, PhD, MBA, an associate professor of public health sciences at the University of North Carolina at Charlotte, to articulate the challenges that COPD patients face and how COPD expenditures might be reined in.
MHE: How do COPD patients mask their symptoms?
Blanchette: They might take the elevator instead of the stairs or they might stop being as active as they used to be; hence, they end up being diagnosed at stage 3 instead of stage 1.
It is important that these patients receive an earlier diagnosis by better screening patients who are current or former smokers and have the symptoms of wheezing, coughing, and/or sputum production.
MHE: What is the roll of controller therapy in reducing COPD costs?
Extremely important. Once a definite COPD diagnosis has been made, the patient should be immediately placed on a type of controller therapy. But adherence to the medication is key.
Controllers all have different breathing systems. However, sometimes the patient does not use the correct system or the device does not work for them. Therefore, the patient does not receive the benefits of the drug, so they end up in the emergency room or hospital.
Patients also need to be shown how to use an inhaler and providers should ensure that patients can use the device before being discharged. Additionally, if the drug tastes bad or makes the patient’s mouth dry, the patient may discontinue use completely.
The reality is that 20% of COPD patients are responsible for 80% of the cost, which now stands at roughly $50 billion a year in the U.S. Just between 2003 to 2010 alone, costs increased from $32 billion to $39 billion. The disease is still out of control.
MHE: Isn’t that due largely due to increased prevalence, though?
Blanchette: Yes, but COPD is a dormant disease. For example, smokers end up with COPD 20 to 30 years after starting smoking, despite the fact that the rates of smoking have decreased over the past 10 to 15 years.
The sheer volume of older adults is also contributing to rising COPD costs.
Next: What can healthcare organizations do to reduce COPD expenditures?