COPD Management Terminology
The comprehensive approach to managing COPD is called "Integrative Care" or "Integrated Care Programs" 1. This term encompasses the multidisciplinary, coordinated management strategies that combine various therapeutic interventions across different healthcare settings.
Core Components of Integrative Care
Integrative care programs improve several clinical outcomes in COPD, though notably not mortality 1. These programs are structured around several key elements:
Primary Management Components
Pulmonary Rehabilitation: A comprehensive intervention based on thorough patient assessment followed by patient-tailored therapies including exercise training, education, and self-management interventions aimed at behavior changes 1
Education and Self-Management: Formal delivery of information on COPD-related topics including smoking cessation, correct inhaler technique, early recognition of exacerbations, and decision-making about when to seek help 1
Action Plans: Written negotiated plans for worsening symptoms that may lead to less respiratory-related hospitalization, though the health benefits may be negated by increased mortality in some studies 1
Case Management: A collaborative process of assessment, planning, facilitation, care coordination, and evaluation through structured follow-up and communication with healthcare professionals 1
Additional Management Elements
Long-Term Oxygen Therapy (LTOT): For patients with chronic respiratory failure and severe resting hypoxemia, administered >15 hours daily 1
Pharmacologic Management: Including bronchodilators, inhaled corticosteroids, and combination therapies 1
Palliative and End-of-Life Care: Focused on preventing and relieving suffering and improving quality of life regardless of disease stage 1
Important Caveats
Close contact with patients who have high disease burden is crucial for maximizing success of integrative care programs 1. However, evidence shows conflicting results:
- One comprehensive case management trial was prematurely discontinued due to excessive mortality in the intervention group 1
- A large multicenter study within an existing well-organized system of care did not confirm benefits of integrated care 1
- Telemedicine-based integrated interventions provided no significant benefit 1
Variations in program components, intervention duration, and measured outcomes have led to uncertainty about developing successful integrative care models 1.