1996 OPEN FORUM Abstracts
Outpatient Management and Rehabilitation
Andrew L. Ries, MD Sunday, November 3, 1996
The outpatient management of the patient with COPD involves educating patients about the disease and its management and involving them actively in partnership with clinicians to control and manage symptoms, slow disease progression, prevent complications, encourage a healthy lifestyle, and maintain functional status and quality of life. Even with advanced disease, preventive health care strategies are important, such as smoking cessation, influenza and pneumococcal vaccination, regular pharmacologic therapy, oxygen for patients with hypoxemia, and pulmonary rehabilitation. This discussion will touch briefly on the importance of smoking cessation and pulmonary rehabilitation.
Smoking cessation is important, even in patients with advanced disease. It is a key preventive health strategy in every stage of disease. COPD is a chronic disease which progresses over time. In susceptible smokers, lung function declines at an accelerated rate. The rate of progression depends critically on the smoking status. The primary objective in management of a chronic disease is maintaining function and slowing disease progression. Advice from the clinician, especially the physician, is an important and effective smoking cessation tool. It is important to assess the patient's readiness for smoking cessation, following the stages on the behavioral cycle: precontemplation, contemplation, preparation, action, and maintenance. The role of the clinician is to help the patient to move through these stages. Assessing the patient's smoking status, emphasizing the benefits of quitting, making a clear recommendation, setting a quit date, providing continued reinforcement and follow-up, and supporting the patient through periods of relapse are some of the simple techniques that can be used in the clinical setting.
Pulmonary rehabilitation is an established technique that can be very helpful as a means to enhance standard medical therapy and reduce disability for patients with chronic lung diseases. The primary goal is to restore the patient to the highest possible level of independent function. This may be accomplished by helping patients become more knowledgeable about their disease, more actively involved in their own health care, more independent in performing daily care activities, and, therefore, less dependent on others. Any patient with chronic lung disease who is symptomatic with significant limitations in functional status and quality of life after appropriate diagnosis and medical therapy is a candidate for pulmonary rehabilitation. A typical program includes interdisciplinary participation by physicians, nurses, respiratory and physical therapists, psychologists, and other health care professionals with particular expertise. The program should be tailored to the needs of the individual patient and, to be successful, address important emotional and psychosocial problems as well as physical ones. The components of a comprehensive program include education, instruction in chest physiotherapy techniques, psychosocial support, and exercise training. Results have demonstrated significant benefits for patients with COPD and other lung diseases. Pulmonary rehabilitation has proven to be cost-effective in decreasing hospitalization days and the use of expensive medical resources. After rehabilitation, patients have an improved quality of life with reduced symptoms, increased exercise tolerance, more independence, increased ability to perform activities of daily living, and improvement in psychological function with less anxiety and depression and increased feelings of hope, control, and self-esteem.
American Thoracic Society: Standards for the diagnosis and care of patients with chronic obstructive pulmonary disease (COPD) and asthma. Am Rev Respir Dis 152:S78-S121, 1995.