COPD stands for complex obstructive pulmonary disease

Abstract

Chronic obstructive pulmonary disease (COPD) has extensively been reported as a complex disease affecting patients' health beyond the lungs with a variety of intra- and extrapulmonary components and considerable variability between individuals. This review discusses the assessment of this complexity and underlines the importance of transdisciplinary management programmes addressing the physical, emotional and social health of the individual patient.COPD management is challenging and requires advanced, sophisticated strategies meeting the patient's individual needs. Due to the heterogeneity and complexity of the disease leading to non-linear and consequently poorly predictable treatment responses, multidimensional patient profiling is crucial to identify the right COPD patient for the right treatment. Current methods are often restricted to general, well-known and commonly used assessments neglecting potentially relevant (interactions between) individual, unique "traits" to finally ensure personalised treatment. Dynamic, personalised and holistic approaches are needed to tackle this multifaceted disease and to ensure personalised medicine and value-based healthcare.

Animal Models Reflecting Chronic Obstructive Pulmonary Disease and Related Respiratory Disorders: Translating Pre-Clinical Data into Clinical Relevance

“…COPD is a complex disease involving various inflammatory pathways that have proved difficult to understand in the context of disease progression [36,38,[93][94][95]. One theory proposes that protease/anti-protease imbalances and oxidative stress are the main mechanisms contributing to COPD pathogenesis ( Fig.…”

“…Chronic bronchitis (productive cough that lasts for 3 months or more per year, for at least 2 years) can occur separately or combined with emphysema in COPD, where the latter diagnosis is based on spirometry. Decline in respiratory function is heterogeneous amongst patients, with some experiencing rapid, almost immediate reduction in lung function whilst others experience a more gradual decline [34][35][36][37][38][39]. The resultant airway damage, lack of elastic lung recoil, and pulmonary obstruction is irreversible, with no cure currently available.…”

Patient assessment and selection for pulmonary rehabilitation

“…Additional factors such as medical co‐morbidities, anxiety, depression, coping strategies, disease knowledge and general health literacy, self‐efficacy, disease exacerbations, complex medication regimens, supplemental oxygen and/or NIV (where needed), hospitalizations and healthcare costs all influence the ultimate impact of the disease on the patient. PR is, indeed, an opportunity to provide individualized, personalized treatment to address many of these issues . As such, where possible, assessment and outcomes measurement regarding these and/or other additional patient features are desirable.…”

“…Importantly, patients have a wide spectrum of needs from PR. Some may principally require exercise training and symptom management, whereas others who are medically complex with multi‐morbidity may require a PR programme with multidisciplinary staff as well as the ability to assess a broader base of patient characteristics, undertake a more comprehensive set of rehabilitation interventions and measure a broader range of PR outcomes . In general, however, patient assessment and outcomes measurement are necessary to assess and monitor patients' progress, ensure patients' safety, ensure quality and safety of the PR programme, enable quality improvement initiatives and ensure payer/insurance reimbursement for PR services .…”

“…The structure and content of PR programmes also vary widely within and across countries . The staffing, structure and resources of individual PR programmes influence the number, medical severity and complexity of patients that can be accommodated . While programmes with experienced multidisciplinary teams of healthcare professionals, expansive space and multispecialty equipment can typically accommodate medically complex patients with severe functional disability, those operating in limited space with limited exercise equipment and/or that are staffed by only one to two healthcare providers may, by necessity, limit their enrolment to patients of lesser disease severity and/or complexity.…”