Identifying chronic obstructive pulmonary disease in primary care of urban underserved patients: tools, applications, and challenges.

Among urban low-income and minority patients with compromised access or low adherence to primary care, exacerbations of unrecognized but symptomatic moderate to severe chronic obstructive pulmonary disease (COPD) cause avoidable emergency room visits and hospitalizations. Detection and management of COPD before a first exacerbation reduces morbidity and disability, forestalls cardiorespiratory complications, improves health-related quality of life, and reduces health care costs. However, current efforts in ascertainment and care of COPD have insufficiently improved outcomes in underserved groups.