Management of patients during and after exacerbations of chronic obstructive pulmonary disease: the role of primary care physicians

Abstract

Current treatments have failed to stem the continuing rise in health care resource use and fatalities associated with exacerbations of chronic obstructive pulmonary disease (COPD). Reduction of severity and prevention of new exacerbations are therefore important in disease management, especially for patients with frequent exacerbations. Acute exacerbation treatment includes short-acting bronchodilators, systemic corticosteroids, and antibiotics if bacterial infections are present. Oxygen and/or ventilatory support may be necessary for life-threatening conditions. Rising health care costs have provided added impetus to find novel therapeutic approaches in the primary care setting to prevent and rapidly treat exacerbations before hospitalization is required. Proactive interventions may include risk reduction measures (eg, smoking cessation and vaccinations) to reduce triggers and supplemental pulmonary rehabilitation to prevent or delay exacerbation recurrence. Long-term treatment strategies should include individualized management, addressing coexisting nonpulmonary conditions, and the use of maintenance pharmacotherapies, eg, long-acting bronchodilators as monotherapy or in combination with inhaled corticosteroids to reduce exacerbations. Self-management plans that help patients recognize their symptoms and promptly access treatments have the potential to prevent exacerbations from reaching the stage that requires hospitalization.

Precipitating causes and outcomes of chronic obstructive pulmonary disease exacerbation at a tertiary care center in northeast Thailand

“…The mean episodelevel costs were $305 for an outpatient visit, $274 for an urgent outpatient visit, $327 for an emergency department visit, $9,745 for a standard admission, and $33,440 for an ICU stay [24]. Long-term treatment with long-acting bronchodilators or in combination with inhaled corticosteroids to reduced exacerbation, and long-term home oxygen therapy (in indicated cases) will improve long-term outcomes [16,26].…”

Standards of suitability for the management of chronic obstructive respiratory diseases

“…Finally, the last statement of this session concerned the assistance out of hospital and was based on the following assertions: the greater part of costs relative to AECOPDs is determined by hospital admission and correlated with the clinical severity, with a large geographical variability, and linked to treatment protocols [ 67 , 68 ]; early discharge from hospital may be favored by the presence of effective services of assistance at home. Selected patients should be admitted to intermediate institutional health structures intermediate between hospital and home, even if the advantages of these structures in terms of treatment efficacy, patients preference and costs still have to be defined [ 69 – 71 ].…”

Chronic Obstructive Pulmonary Disease and Extrapulmonary Effects: Cognitive Impairment

“…Regarding home-based interventions, patients should be involved in monitoring and treating themselves, as it is important to maintain the self-care of the patients. 66 Cognitive dysfunction has been reported as a limiting factor of self-care in patients with COPD. 67 Therefore, the level of cognitive function of these patients must be considered before planning treatment.…”

“…67 Therefore, the level of cognitive function of these patients must be considered before planning treatment. 66 In addition to the risk of developing dementia, maintenance or improvement of cognitive function in the patients with COPD may also enhance self-care of the patients and support other interventions.…”