About the Resource Center and Its Mission
Chronic obstructive pulmonary disease (COPD) is a major cause of preventable morbidity and premature death and its burden has grown over the last several decades. Management of COPD is continually evolving but the treatment and management of patients continues to be suboptimal.
Patients with COPD are a challenge in the clinical setting because many do not present with symptoms until they experience an exacerbation and are often not diagnosed until irreversible airway changes are present. The Global Initiative for Chronic Obstructive Lung Disease (GOLD) define COPD as a preventable and treatable disease characterized by airflow limitation that is not fully reversible and usually is progressive. The GOLD guidelines recommend treatment via an evaluation that includes spirometry results, symptom severity, and exacerbation risk. The patient classification guidelines assign patients to one of four groups according to the degree of airflow based on spirometry, symptom severity, and exacerbation risk. Exacerbations are a symptom based on several subjective and objective criteria and require a change in medication and treatment.
The primary goals of COPD management are to reduce symptoms and prevent and treat exacerbations and complications using both non-pharmacologic and pharmacologic methods. Smoking cessation, immunizations, inhaled bronchodilators, and inhaled corticosteroids are among the key components of a comprehensive treatment strategy, with medications added in a stepwise fashion as the disease worsens.
Several factors interfere with the successful management of a COPD exacerbation and allowing for a successful transition to home or a different level of care. These include suboptimal therapy, lack of education and counseling, and inadequate access to medications and ancillary services. Care for COPD patients requires a conscious shift from provider driven medication selection to patient-centered integrated care. Quick relief and maintenance medication effectiveness are dependent on the medications reaching the lungs which is far more complicated than swallowing a pill. Inhalation therapy requires complex cognition, dexterity, inspiratory effort and breath hold. Also involved is proper assembly, priming, sequencing and cleaning steps of the device used to deliver the medication. Patients who are acutely ill, especially with hypoxia or hypercapnia, may not process vital educational attempts at comprehensive transitional planning.
There are numerous opportunities available for the interprofessional team to help patients with COPD and to improve transitions of care from admission to the acute care facility through discharge to a rehabilitation facility, long-term-care facility, or home. It is vital that patients’ adherence to medication therapy be monitored in a manner that will achieve optimal patient outcomes. This includes the continued evaluation of each patients cognitive and physical attributes when selecting appropriate medications and their corresponding delivery devices. Patients should receive written action plans and be counseled on an ongoing basis in all care settings. Such measures to facilitate best practices in the transition of care should lead to improved quality of life and fewer admissions to the hospital.
This resource center is designed to provide tools and resources for pharmacists, physicians, nurses, and other health care professionals to improve the care of patients with COPD. Improving care starts with admission and continuing as they transition from the hospital to the rehabilitation/long term care setting or to home.
Hippocrates said, "It is far more important to know what person has the disease than what disease the person has.” This philosophical approach is vital for successful care transitions for patients and families living with COPD.