Pulmonary Disorders: COPD

Asthma/COPD Syndrome

An increasing interest in defining subtypes (phenotypes) of COPD as they relate to treatment response, disease progression, symptom complexes has led to the specification of the asthma-COPD phenotype or syndrome. Several studies have reported on this syndrome, though the prevalence has varied significantly, depending on the criteria used in the various studies. Overlap between the disorders has been reported to be up to 55%. The important issue in relation to LEOs is that the asthma/COPD overlap is more common in persons with mild COPD and is linked with a worse outcome in at least one study.26 Additionally, this dual disorder phenomenon brings up the issue that a number of persons with asthma will, eventually, also meet criteria for COPD.

NOTE TO POLICE PHYSICIAN: The following form has been developed to help expedite gathering the most cogent information for police physicians to make clearance decisions. Since many treating providers may not be willing to spend the time to fill out a form, it may be easier to simply request medical records. In that case the following form may be used as a template for extracting the relevant information from the medical records.
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TO: Physician treating or evaluating the following person for performance of law enforcement essential job functions.

Examinee Name:___________________________________________ DOB_________

You are being asked to evaluate this individual in regard to Chronic Obstructive Pulmonary Disease (COPD). It is essential that this person undergo an individualized assessment of his/her COPD to determine whether the individual’s condition permits safe and effective job performance. This evaluation is based on guidance from the American College of Occupational and Environmental Medicine (ACOEM).

A. Introduction:

The well-motivated LEO with COPD who is well-educated regarding the disorder may be capable of safe and effective job performance. An individualized assessment of the applicant or LEO with COPD should be performed including the following:

• Detailed history and physical examination
• Standardized Testing (e.g., spirometry/PFT, chest x-ray, alpha-1 antitrypsin, etc.) when indicated
• Diagnosis (classification and causation)
• Evaluation of treatment plan for optimization
• Frequency of exacerbations and last exacerbation occurrence
• Medication regimen
• Response to medication regimen
• Complications or activity-limiting side-effects from medication regimen
• Compliance with therapy
• Risk of exacerbations
• Planning for on-going surveillance

Assessing the risk of inability to safely and effectively perform essential law enforcement job functions, or of experiencing a sudden impairment rendering the LEO unable to do so, is the major concern in evaluating LEOs with lung diseases. Law enforcement activities involve several issues that need to be considered in regard to those with COPD:

• Unanticipated extreme physical activity that, if not executed properly, could result in death or severe disability to others or the LEO.
• Exposure to environmental provocative agents – e.g., dust, allergens, cold, dry air.
• Exposure to tear gas and “pepper spray”

B. Assessment

I am a pulmonologist or physician experienced in the diagnosis and treatment of COPD. Ο Yes Ο No

1. The examinee has been under my care for COPD since ____

2. I have reviewed outpatient and in-patient medical record(s) of the last 1 year or since date of diagnosis (whichever is shorter)
Ο Yes Ο No

If No, please explain
___________________________________________________
___________________________________________________

Date COPD diagnosed:___________________

3. Has this person any objective testing (pulmonary function testing, challenge testing, etc.) for COPD within the past year? Ο Yes Ο No
If YES, supply a copy of the results.

4. Has this person completed a COPD-specific health status questionnaire? (COPD Assessment Test (CAT™) or COPD Control Questionnaire (CCQ(C)) Ο Yes Ο No
If YES, supply the date and score of the most recent test.

5. Medication Regimen
a. Current COPD medications:
____________________________________________________________________

____________________________________________________________________

b. When was the last time the medication regimen was changed?_________________________

6. Has this individual been educated in COPD and has he/she been thoroughly informed of the risk of exacerbations and the importance of treatment compliance? Ο Yes Ο No

7. Is the examinee’s activity limited by:
Weather conditions? Ο Yes Ο No

Exposure to environmental factors? Ο Yes Ο No

High-level physical activity? Ο Yes Ο No

If YES, please specify_______________________________________________

___________________________________________________________________

Please provide additional information, not included above, that may be helpful to the police physician.

_________________________________________________________________________

_________________________________________________________________________

_________________________________________________________________________

_________________________________________________________________________

_______________________           __________

Signature of Physician       |     Date

___________________________        _______________

Printed name of Physician    |    Phone