Chronic Obstructive Pulmonary Disease, as the name suggests, is characterized by a chronic airflow obstruction in the bronchi and in contrast to asthma, this limitation is poorly reversible and progressively worsens. The diagnosis of COPD is based on spirometry, a test available to primary care and nurses trained in the technique. According to an EPI-SCAN study of 2006-2007, the prevalence of COPD in the Spanish population aged 40 to 80 years is 10.2% (95% CI 9.2-11.1), with a stronger presence in men than in women (Soriano, 2010).
In this review, analysts chose 32 studies, of which 20 were clinical trials and concluded that programs that successfully reduced unscheduled hospital admission of COPD patients had to deploy at least two of the following characteristics:
Care programs for COPD patients that meet the requirements in the table above reduce emergency room visits and hospitalizations, but instead fail to improve symptoms or lung function or patients’ life quality. Therefore, the exacerbations are equally occurring, although many of them are treated at home.
In the Hospital Clínic of Barcelona there is a very active group in the development of programs for patients with COPD, and in a clinical trial (Casas 2006) held in Barcelona and Leuven they showed that an "Integrated Care" intervention with an individualized therapeutic plan shared between specialists and family physicians, the support of a case manager nurse and telephone accessibility, plus an information system based on a web page, succeeded in reducing hospital admissions significantly.
The same team of pulmonologists from Hospital Clínic, in a previous study (Hernández 2003), also showed that home hospitalization for exacerbations in patients with COPD could reduce costs they say, by 38%, increasing the patients’ feeling of comfort and avoiding the risks of hospital infections.
Discussion
The post’s initial question of whether you can improve the COPD patient's quality of life isn’t easy to answer because it’s about a disease with complex management, which usually has a gradual evolution with stable periods combined with exacerbations. Because of this, apart from considerations of cost-effectiveness, which, incidentally, does not have enough solid evidence (with apologies to the Hospital Clínic colleagues), it seems that what is needed is the multidisciplinary approach at community level (integrated care), combined with educational programs to improve self-care and thus, although it can not influence the course of the disease, at least it can make life easier and more comfortable for patients.
Regarding the scarcely avoidable hospital admissions, it’s very fitting for specialists and nurses who are responsible for the patient during hospitalization to be aware that they should as much as possible coordinate the time and the conditions of discharge with their colleagues in primary care units which will then continue to work with the patient in their natural habitat.
Bibliography
Soriano JB, Miravitlles M, Borderías L et al. Diferencias geográficas en la prevalencia de EPOC en España: relaciones con tabaquismo, tasa de mortalidad y otros determinantes. Arch Bronconeumol 2010; 46 (10) :522-30
Jordi Varela
Editor
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