COPD should be a priority

BACKGROUND

From a recent pilot study1, chronic obstructive pulmonary disease (COPD) was found to be among the first cause for hospital admissions, most commonly than acute myocardial infarction and pneumonia. A shift of the paradigm for healthcare from acute to chronic care is required for the optimal management of patients with COPD and other chronic diseases.

 

 

COPD should be a priority because:

  • COPD will become the third leading cause of death in 2020 (GOLD).
  • COPD is an epidemic: As is the case for MI in CVD, COPD exacerbations are treatable and preventable, and early treatment can reduce the risk of complications such as hospitalizations, early mortality and poorer QOL2.
  • We have guidelines on best practices in terms of both pharmacological and non-pharmacological treatments, designed to optimize patient care. However, there are gaps in care.
  • COPD exacerbations are the Number One cause of hospitalizations, ahead of CVD; based on a survey of 10 sites across Canada.
  • Exacerbations are to COPD what a myocardial infarction is to cardiovascular disease: 22-43% of patients hospitalized with a COPD exacerbation die within 1 year, while 25-38% of patients die within 1 year of a first myocardial infarct 3,4. COPD patients have a mean of two exacerbations per year. Exacerbations are severely distressing events that impact greatly on health status, loss of symptom control, and activities of daily living.
  • COPD exacerbations in the ER setting can be detected by doing a spirometry test. When they are identified, there should be standard practices for dealing with them. The focus should not only be on treating the acute event, but also on taking the opportunity to improve the management of the underlying chronic condition which includes diagnosis, assessment of disability and its severity, as well as prevention and early treatment of future exacerbations.

Good news: when you treat an exacerbation early by optimizing COPD treatment, you can prevent exacerbations or at least their complications.


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[1] K.R. Chapman. M. Buthan, J. Bourbeau et al. The hospital burden of COPD in Canada. Abstract 1137. ATS 2010.

[2] O'Donnell DE, Aaron J., Bourbeau J. et al. Canadian Thoracic Society recommendations for management of chronic obstructive pulmonary disease - 2007 update. Can Respir J 2007;14(Suppl B):5B-32B.

[3] Almagro P, Calbo E, Ochoa E et al. Mortality after hospitalization for COPD. Chest 2002; 121(5):1441-1448.

[4] Thom T, Haase N, Rosamond W et al. Heart disease and stroke statistics--2006 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation 2006; 113(6):e85-151

Exacerbations are to COPD what a myocardial infarction is to cardiovascular disease