Breathing Life Into COPD Management: Ongoing Monitoring, Pulmonary Rehabilitation, and Individualized Care

Abstract

As seen in this CME online activity (available at http://copdcme.elsevierresource.com/, COPD is characterized by pulmonary airflow obstruction that is not completely reversible. COPD presents clinically with diverse phenotypes ranging from relatively asymptomatic people to patients with severe chronic cough, abnormal sputum production, and dyspnea with exertion. Exacerbations accelerate the downward cycle of breathing difficulties, activity avoidance, and physical decline that characterizes progressive COPD. Consequently, patients with COPD should be repeatedly assessed for symptom severity and duration, previous exacerbations, the degree of airflow limitation, and confounding comorbidities. Spirometry should be used to clarify COPD prognoses and longitudinally classify the disease from mild to very severe. Conversely, spirometry does not always capture the wide-ranging effects of COPD on patient function and quality of life, and other clinical assessment tools and evaluation strategies should be used to longitudinally monitor patients. Although COPD cannot currently be cured, all disease stages can be treated to slow progression, minimize symptoms, prevent exacerbations, and maximize function and quality of life. Importantly, all patients should participate in comprehensive pulmonary rehabilitation regardless of disease stage. Patients and providers, however, can be unaware of potential benefits or reluctant to initiate this modality. In many practice settings, finding a pulmonary rehabilitation program to accept the patient can be difficult, highlighting the need for well-defined referral pathways. Almost all patients with COPD also require pharmacotherapy to control symptoms, reduce complications, and maximize lung function. Evidence-based education that addresses individualized maintenance regimens are needed to improve long-term outcomes in COPD. Within this CME/CE Snapshot educational series, an expert pulmonologist and a primary care educator discuss how to best longitudinally evaluate patients with COPD and incorporate the principles of pulmonary rehabilitation to maximize patient function and quality of life. They explain therapeutic tailoring over the course of disease and describe the importance of engaging patients in shared decision-making to promote acceptance of the diagnosis, appropriate physical activity, and treatment adherence.