EMS, Field Identification Of Chronic Obstructive Pulmonary Disease (COPD)

Chronic obstructive pulmonary disease (COPD) is a common co-morbidity and cause of new complaints. Rapid recognition, assessment, and treatment are paramount to patient outcomes. Gone are the days of definitive airway management as first-line therapy. The scope of practice has expanded and the expectation of medical care to prevent respiratory collapse or failure along with it. With an aging population who spent much of their youth with high prevalence of smoking, COPD is a diagnosis that continues to rise as evidenced by the incidence of EMS calls and emergency room (ER) visits. Patients do not always recognize the diagnosis of COPD due to lack of medical access, desire to seek medical attention, or insufficient medical literacy. There is a clear increased predominance of COPD in lower-income areas with the above-increased risk factors. This care burden often lands on those providing emergency care. If the patient has a known diagnosis and is either known to you or can communicate thier diagnosis of COPD, it becomes straightforward to recognize their clinical condition. However, if they are unable, do not know, or have confounding disease processes, then it falls to the clinician to determine the etiology of the complaint and plan rapid, appropriate treatment.[1][2][1] The Global Initiative for Chronic Obstructive Lung Disease (GOLD) recognizes COPD as the fourth leading cause of death worldwide, and it is expected to assume the number 3 spot by 2020. Most often, the reported complaint will be respiratory, for example, shortness of breath, difficulty breathing, dyspnea, or a cough. Additionally, it may also be complaints of chest pain, fever, or other broad complaints. If the patient is not in a life-threating condition, appropriate history and physical can guide the diagnosis and subsequent treatment. There are differential diagnosis that must be accurately assessed, as incorrect diagnosis can increase strain on a failing system and cause a rapid patient decline.[3]