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Innovations to achieve excellence in COPD diagnosis and treatment in primary care.
Postgrad Med 2010; 122(5):150-64PM

Abstract

Recognition of chronic obstructive pulmonary disease (COPD) is often missed or delayed in primary care. Once recognized, COPD is often undertreated or episodically treated, focusing on acute exacerbations without establishing maintenance treatment to control ongoing disease. Diagnostic and therapeutic pessimism result in missed opportunities to reduce exacerbations, maintain physical functioning, and reduce emergent health care requirements. Proactive diagnosis and evidence-based management can alleviate the impact of COPD on patients' lives. Smoking cessation has been proven to slow the rate of lung function decline. Maintenance pharmacotherapy and immunizations reduce exacerbations. Pulmonary rehabilitation improves respiratory symptoms and physical functioning and reduces rehospitalizations after exacerbations. Self-management education improves health-related quality of life and reduces inpatient and emergency care usage. Maintenance treatment with long-acting inhaled bronchodilators is appropriate beginning in moderate COPD to maintain airway patency and reduce exacerbations. Tiotropium is US Food and Drug Administration (FDA) approved to treat bronchospasm and reduce exacerbations in patients with COPD; salmeterol/fluticasone is FDA approved to treat airflow obstruction in COPD and reduce exacerbations in patients with a history of exacerbations. Other maintenance long-acting bronchodilators-salmeterol, formoterol, and budesonide/formoterol-are FDA approved to treat airway obstruction in COPD but lack an approved indication against exacerbations. FDA warnings on the use of long-acting beta-adrenergic agents (LABAs) in asthma specifically exempt COPD and do not apply to LABA/inhaled corticosteroid combinations used in COPD. The actual effectiveness achieved in practice with any COPD therapies depends on patients' inhaler technique, adherence, and persistence. Medication usage rates and inhaler proficiency may be improved by concordance, in which the health care provider and patient collaborate to make treatment plans sustainable in the patient's daily life. Practice redesign for whole-patient primary care provides additional tools for comprehensive COPD management. Innovations such as group visits and the patient-centered medical home provide newer ways to interact with COPD patients and their families. Patient-focused and evidence-based options enable primary care practices to manage COPD longitudinally and improve patient outcomes through the course of the disease.

Authors+Show Affiliations

Department of Family Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA. lf@grouppracticeforum.comNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

20861599

Citation

Fromer, Len, et al. "Innovations to Achieve Excellence in COPD Diagnosis and Treatment in Primary Care." Postgraduate Medicine, vol. 122, no. 5, 2010, pp. 150-64.
Fromer L, Barnes T, Garvey C, et al. Innovations to achieve excellence in COPD diagnosis and treatment in primary care. Postgrad Med. 2010;122(5):150-64.
Fromer, L., Barnes, T., Garvey, C., Ortiz, G., Saver, D. F., & Yawn, B. (2010). Innovations to achieve excellence in COPD diagnosis and treatment in primary care. Postgraduate Medicine, 122(5), pp. 150-64. doi:10.3810/pgm.2010.09.2212.
Fromer L, et al. Innovations to Achieve Excellence in COPD Diagnosis and Treatment in Primary Care. Postgrad Med. 2010;122(5):150-64. PubMed PMID: 20861599.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Innovations to achieve excellence in COPD diagnosis and treatment in primary care. AU - Fromer,Len, AU - Barnes,Thomas, AU - Garvey,Chris, AU - Ortiz,Gabriel, AU - Saver,Dennis F, AU - Yawn,Barbara, PY - 2010/9/24/entrez PY - 2010/9/24/pubmed PY - 2010/11/9/medline SP - 150 EP - 64 JF - Postgraduate medicine JO - Postgrad Med VL - 122 IS - 5 N2 - Recognition of chronic obstructive pulmonary disease (COPD) is often missed or delayed in primary care. Once recognized, COPD is often undertreated or episodically treated, focusing on acute exacerbations without establishing maintenance treatment to control ongoing disease. Diagnostic and therapeutic pessimism result in missed opportunities to reduce exacerbations, maintain physical functioning, and reduce emergent health care requirements. Proactive diagnosis and evidence-based management can alleviate the impact of COPD on patients' lives. Smoking cessation has been proven to slow the rate of lung function decline. Maintenance pharmacotherapy and immunizations reduce exacerbations. Pulmonary rehabilitation improves respiratory symptoms and physical functioning and reduces rehospitalizations after exacerbations. Self-management education improves health-related quality of life and reduces inpatient and emergency care usage. Maintenance treatment with long-acting inhaled bronchodilators is appropriate beginning in moderate COPD to maintain airway patency and reduce exacerbations. Tiotropium is US Food and Drug Administration (FDA) approved to treat bronchospasm and reduce exacerbations in patients with COPD; salmeterol/fluticasone is FDA approved to treat airflow obstruction in COPD and reduce exacerbations in patients with a history of exacerbations. Other maintenance long-acting bronchodilators-salmeterol, formoterol, and budesonide/formoterol-are FDA approved to treat airway obstruction in COPD but lack an approved indication against exacerbations. FDA warnings on the use of long-acting beta-adrenergic agents (LABAs) in asthma specifically exempt COPD and do not apply to LABA/inhaled corticosteroid combinations used in COPD. The actual effectiveness achieved in practice with any COPD therapies depends on patients' inhaler technique, adherence, and persistence. Medication usage rates and inhaler proficiency may be improved by concordance, in which the health care provider and patient collaborate to make treatment plans sustainable in the patient's daily life. Practice redesign for whole-patient primary care provides additional tools for comprehensive COPD management. Innovations such as group visits and the patient-centered medical home provide newer ways to interact with COPD patients and their families. Patient-focused and evidence-based options enable primary care practices to manage COPD longitudinally and improve patient outcomes through the course of the disease. SN - 1941-9260 UR - https://www.unboundmedicine.com/medline/citation/20861599/Innovations_to_achieve_excellence_in_COPD_diagnosis_and_treatment_in_primary_care_ L2 - http://www.tandfonline.com/doi/full/10.3810/pgm.2010.09.2212 DB - PRIME DP - Unbound Medicine ER -