Breathing is automatic, but it's far from effortless for tens of millions of Americans. Chronic respiratory illnesses such as asthma and chronic obstructive pulmonary disease (COPD) affect more than 39 million people in the United States alone, generating millions of emergency department visits and a significant cost burden to patients and the healthcare system.
Primary care physicians (PCPs) are tasked with identifying, treating, and educating patients about these chronic lung disorders. "The role of the primary physician is to identify the condition and assist in making definitive diagnosis and treatment plans," says Jonathan Jennings, MD, an internist at Medical Offices of Manhattan, New York City. "We also assist in educating the patient and family concerning the condition and treatment plans.".
Following are five key strategies PCPs can use to get their patients breathing more easily.
1. Start with an Early and Accurate Diagnosis
Chronic respiratory diseases often are underdiagnosed or misdiagnosed—sometimes for years. Sanjay Ramakrishnan, MD, a board-certified pulmonologist at The Institute for Respiratory Health in Australia, emphasizes the importance of early and accurate diagnosis.
"COPD diagnosis is often delayed," Ramakrishnan says. "Patients may present with chronic cough or low-grade infections that don't seem serious at first, and it may take years before the true cause is recognized."
Diagnostic Tip:
Use spirometry to evaluate lung function when a patient presents with chronic cough and risk factors such as:
- Smoking history
- Childhood respiratory infections
- Long-term exposure to pollutants
Spirometry is a low-cost, non-invasive test that can yield valuable clinical information and guide relevant management.
2. Educate Patients on Warning Signs and Self-Management
Both physicians and patients must be aware of red flags of disease deterioration. Jennings stresses that awareness of patterns of symptoms can prevent emergency admissions and hospitalization.
Warning signs are typically:
- Repeated cough
- Infection or fever
- Dependent more on rescue inhalers
For patients with COPD, recurring exacerbations can trigger the need to change treatment. Blood eosinophil levels (≥300 cells/μL) can tell whether inhaled corticosteroids or biologics such as Dupixent (dupilumab) could be effective.
In trials, Dupixent demonstrated:
34% reduction in exacerbations
More than 2x improvement in lung function after 12 weeks
Monitoring prednisone use also—repeated refills can be a sign of out-of-control disease and can trigger a reassessment of the current treatment plan.
3. Help Patients Quit Smoking and Vaping
Quit is apparently one of the most successful interventions for respiratory health. "If we haven't gotten our patients to their eighth quit attempt, then we haven't tried hard enough," Ramakrishnan emphasizes.
Smoking Cessation Support:
- Offer counseling on each visit
- Prescribe FDA-approved medications to stop smoking
- Add behavioral therapy with pharmacological support
- Consider low-dose CT lung cancer screening among current or former smokers 50 years of age or older.
4. Immunize to Prevent Complications
Chronic respiratory infections can significantly worsen chronic lung disease. Lung injury in asthma and COPD increases patients' risk of severe illness and prolonged recovery.
Vaccines they actually need:
- Influenza (flu)
- COVID-19
- Pneumococcal pneumonia
- Respiratory Syncytial Virus (RSV)
Remind patients to stay up to date with immunizations in order to reduce the risk of complications.
5. Recognize When to Refer to a Specialist
PCPs can manage most chronic respiratory conditions, but there are instances that must be referred to pulmonologists, allergists, or ENT specialists.
Refer for:
- Chronic sinusitis
- Sarcoidosis
- Interstitial lung diseases
- Uncontrolled asthma, COPD, or allergies
- Unclear or overlapping symptoms
Jennings goes on, "One of the biggest responsibilities of the PCP is deciding when to refer a patient to a specialist and guiding patients to the right care team."
Conclusion: Don't Allow Patients to Suffer in Silence
Chronic respiratory disease disproportionately suffers working-class communities, especially in urban areas. Many patients dismiss symptoms, attributing them to age, pollution, or a cold.
"They may dismiss their symptoms as 'just a cough' when it could be a whole lot worse than that," Ramakrishnan says.
PCP doctors are in the best position to rewrite that script. By establishing trust, intervening early on, and individualizing treatment plans, PCPs can empower patients to become their own advocates for respiratory health.
Recall: Early intervention, patient education, lifestyle support, and team care can play a major role in the control of chronic respiratory disease.
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