Disease Management for Chronic Obstructive Pulmonary Disease A Clinical Strategy

Chronic obstructive pulmonary disease (COPD) is a progressive chronic disease that is subject to acute exacerbations. Ideally, a patient with such a chronic disease should be provided with medical care that addresses these issues while empowering the patient to initiate rapid and definitive treatments to counter exacerbations. To do this, disease management for COPD must recognize that, as this disease is chronic and progressive, any intervention must be ongoing and progressive. As timely recognition of, and rapid intervention for, exacerbations is crucial, COPD disease management must be patient centered. The care offered to patients with COPD should include smoking cessation, regular vaccinations for influenza and pneumonia, and instruction on avoidance of respiratory irritants, as well as medications such as bronchodilators and corticosteroids. Daily exercise is essential and pulmonary rehabilitative tools should be employed. Patients with end-stage disease should be assisted in creating advance directives and should be provided with palliative care. The training of patients in the self-management skills of medication self-administration, secretion clearance, pursed lips breathing, walking exercise, and recognition and rapid treatment of exacerbations is integral to a successful COPD disease management program. Doctor's therapeutic office visits guide and practice patients in performance of their daily routines to hone their skills, create habits, and develop positive living patterns. With practice, patients improve these skills over time - counter to the natural disease progression. Outcomes monitoring is necessary in order to evaluate the impact of the intervention, and to improve its efficacy. The Respiratory Disease Management Institute (RDMI) model for COPD is based on the aforementioned considerations. In a total of 1981 doctor's therapeutic office visits over 6 years of this program, 744 exacerbations were identified, with a hospitalization rate of 3.2%. These results compare favorably with those of a previous study. COPD disease management is a systematic approach to the treatment of this chronic disease. When exacerbations are detected in their early stages, they are highly reversible and hospitalization may be avoided. The available data from the RDMI suggest that it is time for a multicenter study to evaluate this model of healthcare delivery for COPD.