Poorly managed, severe COPD can result in repeated exacerbations, hospitalizations, and shortened lifespan.

Fu Y, Chapman EJ, Boland AC, et al. Evidence-based management approaches for patients with severe chronic obstructive pulmonary disease (COPD): A practice review. Palliat Med. 2022 May;36(5):770-782. doi: 10.1177/02692163221079697. Epub 2022 Mar 20.

 

COPD expert Francesca Polverino, MD, PhD, a spokesperson for the American Lung Association and an associate professor at the Baylor College of Medicine, speaks with MDLinx about evidence-based strategies important for effective COPD management.

 

Clear communication is key

 

 

The importance of clear communication is supported by the NIH: Effective communication is imperative for a strong patient-provider relationship, and it results in improved health outcomes, reduced medical errors, and makes the most of what limited time doctors generally have with their patients, one on one.

Talking With Your Older Patients. National Institute on Aging. January 25, 2023.

 

Top tips include avoid rushing the patient, ensuring they are comfortable in the exam room, and anticipating differences in expectations of care rooted in cultural differences.

 

An obvious but necessary strategy

 

 

 

 

A 2023 study, published in BMC Pulmonary Medicine, found that, for patients who quit smoking with 2 years of a COPD diagnosis, they had significantly lower risks of all-cause and cardiovascular mortality compared with persistent smokers.

Doo JH, Kim SM, Park YJ, et al. Smoking cessation after diagnosis of COPD is associated with lower all-cause and cause-specific mortality: a nationwide population-based cohort study of South Korean men. BMC Pulm Med 23, 237 (2023).

 

However, effective patient education was necessary to see these effects. “After receiving information on COPD, 84.1% of high-risk smoking patients showed an increased willingness to quit smoking,” the study authors wrote. “Smoking cessation, by alleviation of the acute inflammatory process, also can lead to reduced risk of COPD exacerbation and improved bronchodilator response.”

Doo JH, Kim SM, Park YJ, et al. Smoking cessation after diagnosis of COPD is associated with lower all-cause and cause-specific mortality: a nationwide population-based cohort study of South Korean men. BMC Pulm Med 23, 237 (2023).

 

 

Personalize your treatment plans

 

Dr. Polverino recommends that HCPs focus on personalized treatment plan. This includes accurately determining phenotype (ie, emphysema vs chronic bronchitis) via chest CT, inquiring about lifestyle choices, documenting comorbidities, and performing regular pulmonary function tests.

 

 

The importance of pulmonary rehabilitation

 

While some patients might be initially resistant, pulmonary rehab can significantly enhance their quality of life.

 

Patients don’t feel they will benefit, but once they do pulmonary rehabilitation, they are quite happy with it.

Indeed, results of a systematic review and meta-analysis published in the Annals of Medicine indicated that patients who participated in a pulmonary rehab program exhibited significant improvements in the 6-minute walk test (6MWT), St. George Respiratory Questionnaire score, and the modified British Medical Research Council score compared with those who received usual care.

Zhang H, Hu D, Xu Y, et al. Effect of pulmonary rehabilitation in patients with chronic obstructive pulmonary disease: a systematic review and meta-analysis of randomized controlled trials. Ann Med. 2022 Dec;54(1):262-273. doi: 10.1080/07853890.2021.1999494.

 

“The main purpose of pulmonary rehabilitation training is to formulate a corresponding program according to the actual situation of the patient to improve the patient’s quality of life and exercise endurance and improve the symptoms of dyspnoea,” the review authors wrote.

Zhang H, Hu D, Xu Y, et al. Effect of pulmonary rehabilitation in patients with chronic obstructive pulmonary disease: a systematic review and meta-analysis of randomized controlled trials. Ann Med. 2022 Dec;54(1):262-273. doi: 10.1080/07853890.2021.1999494.

 

 

Take a holistic approach

 

Dr. Polverino emphasizes the importance of educating patients about the holistic approach to managing COPD. This comprehensive strategy not only involves guiding them on managing exacerbations but also covers essential aspects such as physical activity, nutrition, oxygen therapy, and vaccination.

 

Encourage higher patient education beyond pharmacologic treatment.

Most experts agree that the complex nature of COPD necessitates a multidisciplinary approach. ”We must look at the whole patient—their nutrition, mental health, and even their end-of-life care planning,” Alok Mohta, MD, MBBS, tells MDLinx.

For high-risk COPD patients, the value of a multidisciplinary approach cannot be overstated.

Research strongly supports this approach; consider the following:

• A 2024 study in The Netherlands showed that multidisciplinary consultation (MDC) improved care for severe COPD patients. In 84% of the 61 cases reviewed, different and more integrated treatments were recommended, improving care coordination and reducing unnecessary referrals.

  Hekking PP, van Meggelen M, Lie WJ, et al. Severe COPD: multidisciplinary consultation to get the right care at the right place. Int J Chron Obstruct Pulmon Dis. 2024;19:749–752.

   

• In a 2020 American cohort study, 24% of COPD patients showed improvement in their BODE scores (evaluates BMI, Obstruction in airflow, Dyspnea, and Exercise Capacity) with MDC. Cases with higher baseline symptom severity were more likely to improve.

  Mansoor S, Obaida Z, Ballowe L, et al. Clinical impact of multidisciplinary outpatient care on outcomes of patients with COPD. Int J Chron Obstruct Pulmon Dis. 2020;15:33–42.

   

   

“The best outcomes often come when pulmonologists, respiratory therapists, nutritionists, and palliative care specialists work in tandem,” Dr. Mohta says.