Patients with Chronic Obstructive Pulmonary Disease

Abstract

For many years, chronic obstructive pulmonary disease (COPD) has been under-recognized and stigmatized. Misconceptions about this disease have led to under-treatment and under-funding, resulting in an increase in the burden of COPD. In 2005, the National Emphysema/COPD Association published the results of a set of national surveys of patients, primary care physicians, and pulmonologists. The findings of these surveys indicated that activity limitation was prevalent among patients with COPD, and that, although most physicians believed that effective therapy could slow the progression of COPD, their inadequate knowledge and poor adherence to practice guidelines had a negative impact on the care of patients with COPD. Patients with COPD may not be optimally treated by physicians. Greater attention needs to be paid to effective smoking cessation programs and self-management. Many physicians under-prescribe effective therapies, with some patients experiencing the ill effects of long-term systemic corticosteroids. Ambulatory oxygen is an effective therapy for COPD. However, the use of ambulatory oxygen can make daily living and leisure activities difficult for patients, and thus physicians have difficulty convincing patients to initiate this therapy. Attention needs to be paid to finding the right oxygen delivery system for the patient, and to educating patients on the correct use of this therapy, particularly when travelling. Another important issue surrounding oxygen therapy is sleep anxiety and the fear of breathlessness or dying in one’s sleep. COPD exacerbations have a major impact on quality of life; however, most therapies used to treat exacerbations have been designed for the treatment of asthma. Corticosteroids, antibacterials, and bronchodilators are routinely used for the treatment of exacerbations, but physicians often do not follow practice guidelines. Exacerbation management is too often ‘too little, too late.’ Another area of concern for patients is effective use of inhalers; incorrect inhaler technique is too common. It has been established that pulmonary rehabilitation programs should be an integral part of the management of COPD, particularly in patients with moderate or severe disease. Currently, the availability of pulmonary rehabilitation programs in the US is limited, as reimbursement is either inadequate or not available. In addition, many physicians do not refer patients to these programs when they are available. Medical advances notwithstanding, most patients with COPD demand therapies that are more effective, more enabling, and cause fewer adverse effects than current therapies. The challenge for medical science and the pharmaceutical industry is to bring about a qualitative change in therapy for the acute exacerbations of COPD as well as for the perpetual shortness of breath, which has such a devastating effect on quality of life. It is very encouraging that the medical community is beginning to recognize this challenge and is moving towards treating patients with COPD as ‘whole people’ and training them to self-manage at home. The overall success of these efforts is dependent on the recognition of COPD as a national health priority.