Pulmonary Disorders

Chronic Obstructive Pulmonary Disease

The well-educated, well-motivated LEO with some degree of chronic obstructive pulmonary disease (COPD) may be able to safely and effectively perform essential law enforcement job functions. However, LEOs with COPD may be adversely affected in their ability to perform demanding aerobic activities depending either on the baseline status of their disease or the effect of exacerbations.

Diagnosis of COPD in LEOs is not the job of the police physician. However, understanding basic concepts both of the disease and the diagnostic criteria is important, particularly given the interplay between ability to perform physically demanding work, physiological conditioning and structural pulmonary disease. LEOs with a diagnosis of COPD should undergo evaluation for classification (see Appendix B) as part of any pre-placement, periodic, or fitness-for-duty evaluation. While questionnaire screening of at-risk populations (ever-smokers aged 40-79) has been shown effective in identifying undiagnosed cases that could benefit from treatment, routine spirometry screening of individuals without any symptoms or history of risk factors for COPD has not been shown to be cost-effective in general population studies.1(GOLD 2019)

Mild COPD
LEOs meeting the criteria for mild COPD (see GOLD assessment of airflow obstruction in Appendix B) should undergo a job task simulation testing consistent with their agency’s essential job functions (see Appendix C for discussion of job task simulation testing) without any immediate pre- or during-test use of a short-acting beta agonist (SABA). If LEOs have other contraindications to physical exertion, they should be evaluated by the criteria in the relevant section of these guides.

• LEOs with mild COPD who satisfactorily perform the specified job task simulation testing evaluation should have no restriction from full duty for COPD.
• LEOs with mild COPD who are unable to satisfactorily perform the specified job task simulation testing should be restricted from full duty and referred to their treating physician for re-evaluation and possible modification of current treatment regimen (see Appendix B regarding
  re-assessment).

If/when the LEO is cleared by his/her treating physician to undergo repeat job task simulation testing, that decision should be reviewed by the police physician. If the police physician agrees with the treating physician’s decision, the LEO should repeat the same job task simulation testing previously performed.

• LEOs with mild COPD who satisfactorily perform the repeat job task simulation testing should have no restriction from full duty.
• LEOs with mild COPD who are unable to satisfactorily perform the repeat job task simulation testing, should remain restricted from full duty and be referred back to their treating physician for further assessment regarding the diagnosis as well as the treatment plan (see Appendix B regarding reassessment).

This process may be repeated as per agency policy. However, in order to be cleared for full duty, the LEO with mild COPD should successfully complete job task simulation testing consistent with his/her agency’s essential job functions (see Appendix C).

LEOs with mild COPD who have satisfactorily completed the job task simulation testing and have no restriction from full duty should be monitored on a regular basis. A monitoring schedule should be established by the police physician to assess for progression of the disease and evaluation of exacerbations. Monitoring should be continued, at a minimum, on an annual basis per consensus of the ACOEM LEO Task Group.

Moderate COPD
LEOs meeting the criteria for moderate COPD (see classification scheme in Appendix B) with no history of job performance difficulties potentially due to COPD should be evaluated using a job task simulation testing consistent with their agency’s essential job functions (see Appendix C for discussion of job task simulation testing) without any immediate pre- or during-test use of a short-acting beta agonist (SABA). If LEOs have other contraindications to physical exertion, they should be evaluated by the criteria in the relevant section of these guides.

• LEOs with moderate COPD who satisfactorily perform the specified job task simulation testing should have no restriction from full duty for COPD.
• LEOs with moderate COPD who are unable to satisfactorily perform the specified job simulation task evaluation should be restricted from full duty pending re-assessment by their treating physician (see Appendix B regarding re-assessment).

If cleared by the treating physician to undergo repeat job task simulation testing, that decision should be reviewed by the police physician. If the police physician agrees with the treating physician’s decision to clear for testing, the LEO should repeat the same job simulation task evaluation previously performed. This process may be repeated as per agency policy. However, in order to be cleared for full duty, LEOs should successfully complete a job task simulation testing consistent with their agency’s essential job functions (see Appendix C).

LEOs with moderate COPD who have been re-evaluated, have satisfactorily completed the exercise challenge testing, and have no restriction from full duty should be monitored on a regular basis. A monitoring schedule should be established by the police physician to assess for progression of the disease and evaluation regarding exacerbations. Follow-up on, at minimum,
a semi-annual basis should be continued, per consensus of the ACOEM LEO Task Group.

Severe COPD
LEOs meeting the criteria for severe COPD (see classification scheme in Appendix B) should be restricted from full duty and referred to their treating physician for re-assessment and modification of treatment.

If cleared by the treating physician to undergo job task simulation testing, that decision should be reviewed by the police physician. If the police physician agrees with the treating physician’s decision to clear for testing, the LEO should be evaluated using job task simulation testing (see Appendix C for discussion of job task simulation testing) without any immediate pre- or during-test use of a short-acting beta agonist (SABA). If the LEO has other contraindications to physical exertion, he/she should be evaluated by the criteria in the relevant section of these guides.

• LEOs who satisfactorily perform the job task simulation testing should have no restriction from full duty.
• LEOs who are unable to satisfactorily perform the job task simulation testing, should remain restricted from full duty and be referred back to their treating physician for further assessment regarding the diagnosis as well as the treatment plan (see Appendix B regarding reassessment).

If the LEO is re-cleared by her/his treating physician to undergo job task simulation testing, that decision should again be reviewed by the police physician. If the police physician agrees with the treating physician’s decision to clear for testing, the LEO should repeat the same job task simulation testing previously performed. This process may be repeated as per agency policy. However, in order to be cleared for full duty, the LEO should successfully complete job task simulation testing consistent with his/her agency’s essential job functions (see Appendix C).

LEOs with severe COPD who have been re-evaluated, have satisfactorily completed the exercise challenge testing and have no restriction from full duty should be monitored on a regular basis. A monitoring schedule should be established by the police physician to assess for progression of the disease and evaluation regarding exacerbations. Follow-up on, at minimum, an every-three-month basis should be continued, per consensus of the ACOEM LEO Task Group.

Very Severe COPD
LEOs meeting the criteria for very severe COPD (see classification scheme in Appendix B) should be restricted from full duty and referred to their treating physician for re-assessment and modification of treatment; it is unlikely that persons with this degree of FEV1 loss would be able to safely and effectively perform LEO job functions.

If the LEO is cleared by her/his treating physician to undergo job task simulation testing, that decision should be reviewed by the police physician. If the police physician agrees with the treating physician’s decision to clear for testing, the LEO should be evaluated using job task simulation testing (see Appendix C for discussion of job task simulation testing) without any immediate pre- or during-test use of a short-acting beta agonist (SABA). If the LEO has other contraindications to physical exertion, he/she should be evaluated by the criteria in the relevant section of these guides.

• LEOs who satisfactorily perform the job task simulation testing should have no restriction from full duty.
• LEOs who are unable to satisfactorily perform the job task simulation testing, should remain restricted from full duty and be referred back to their treating physician for further assessment regarding the diagnosis as well as the treatment plan (see Appendix B regarding reassessment).

If re-cleared by their treating physician to undergo job task simulation testing, that decision should again be reviewed by the police physician. If the police physician agrees with the treating physician’s decision to clear for testing, the LEO should repeat the same job task simulation testing previously performed.

• LEOs who satisfactorily perform the repeat the repeat job task simulation testing should have no restriction from full duty.
• LEOs who are unable to satisfactorily perform the second repeat job task simulation testing, should remain restricted from full duty.

This process may be repeated per agency policy. However, to be cleared for full duty, LEOs should successfully complete job task simulation testing consistent with their agency’s essential job functions (see Appendix C).

LEOs with very severe COPD who have been re-evaluated, have satisfactorily completed the job task simulation testing, and have no restriction from full duty should be monitored on a regular basis. A monitoring schedule should be established by the police physician to assess for progression of the disease and evaluation regarding exacerbations. Follow-up, at minimum, every 3 months should be continued, per consensus of the ACOEM LEO Task Group.