CHEST 2025: Improving COPD Outcomes Through Accurate Diagnosis and Standardized Care Pathways

At CHEST 2025, held October 19-22 in Chicago, Illinois, Megan Dulohery Scrodin, MD, a pulmonary medicine physician with Mayo Clinic, sat down with Pharmacy Times® to discuss the key challenges health systems face in managing Chronic Obstructive Pulmonary Disease (COPD). She noted this includes limited access to primary and specialty care, diagnostic uncertainty, and high treatment costs.

Dulohery Scrodin emphasized the importance of confirming COPD diagnoses through spirometry and implementing standardized treatment pathways to improve outcomes and reduce unnecessary therapies. She also highlighted the need for broader screening for genetic risk factors, such as alpha-1 antitrypsin deficiency, and for recognizing asthma-COPD overlap to ensure patients receive the most effective, individualized care.

Pharmacy Times: What are the key challenges health systems face in managing COPD effectively?

Megan Dulohery Scrodin, MD: I think there is a large number. The majority of our COPD patients are actually managed by primary care, and there’s a primary care shortage across the United States. Many patients struggle to even get access to care. Once they do get access, having a clear diagnosis of COPD is also a challenge.

A large number of patients are diagnosed with COPD having never had any type of pulmonary function testing. By definition, we want to see airway obstruction on pulmonary function testing to be confident that we have a correct diagnosis of COPD. Inhaler therapy and more advanced COPD therapies, if used in patients who don’t have a clear diagnosis, have the potential for a lot of financial toxicity as well as side effects for patients. So, establishing the correct diagnosis is really a huge issue.

The next step is that once we have a diagnosis, if we have patients who are not well controlled, access to specialty care can be challenging. Across the United States, there are areas where pulmonologists are not easily located to really be able to help consider those more advanced therapies.

Those are some of our outpatient issues. We also know that COPD in the hospital is a challenge. There are a lot of patients who are admitted every year with acute COPD exacerbations. We know that the index hospitalization is a big event in the life of a COPD patient, and it’s really important that we adjust or change their therapy, or if they don’t have a clear diagnosis, get that clear diagnosis after their hospitalization.

There’s also a gap in care when patients are trying to transition from the inpatient setting to the outpatient setting. Most of those patients, when they get home, continue to be short of breath and are hesitant to leave their home because of the challenges with their breathing. But it’s really important that we get them reconnected with either their primary care provider or their COPD clinician so that they can make appropriate adjustments and treatment.

The last thing I would mention is the cost of therapy—the cost of inhalers, the cost of more advanced therapies, and now with the biologics, not all patients can afford those treatments. We need to continue to advocate for lowered costs of medications to make sure our treatments are accessible to our patients.

Pharmacy Times: How can standardized diagnosis and treatment pathways improve COPD outcomes?

Dulohery Scrodin: I already mentioned that really getting a diagnosis is the first step. I think strategizing ways to make spirometry more accessible across the United States and in any health care system is one of the first priorities. We need to be able to test patients to confirm their diagnosis so that we can get them on the right treatment.

In addition, being consistent with identifying risk factors that predict poor outcomes is also important. Based on guideline-based care, we now recommend that all COPD patients be screened for alpha-1 antitrypsin deficiency, which is one of our genetic causes of COPD. It’s not only associated with COPD but also with asthma and bronchiectasis.

We are probably underdiagnosing people, and identifying this would tell us more about their particular type of lung disease and open up some other treatment opportunities. We really should be screening everybody with COPD, and I would advocate that we probably need to screen before they develop COPD as well.

I think phenotyping patients is also incredibly important so that we can prognosticate and select the best treatment for them. Increasingly, we know that blood eosinophils are important in COPD patients who are frequent exacerbators. I would argue that we need to know that risk factor upfront. When I see a patient in the clinic for COPD, I always get a CBC with differential to look for that eosinophil count.

That may not drive what initial therapy I start, but it might help me advise the patient on what their predictors of risk are. If they’ve not had a COPD exacerbation but are symptomatic and have blood eosinophils greater than 300, I’m likely not going to start an inhaled corticosteroid at that point. But if they contact me and say, “I’m having exacerbations; I’ve ended up on prednisone twice in the last year,” I know that I need to escalate that therapy and that inhaled corticosteroids are the right thing to do for that patient.

I think we also underrecognize asthma-COPD overlap, and the earlier we recognize asthma-related inflammation in the COPD patient—or allergic-type inflammation—the better we’ll be able to get them under control and prevent those exacerbations from happening.