Experts call for re-focussing of COPD management to reduce hospital admissions and mortality
16th November 2005: A new report on the importance of treating Chronic Obstructive Pulmonary Disease (COPD) exacerbations is launched today, on World COPD Day. Global dissemination of the report to family physicians/General Practitioners around the world is being supported and facilitated by Wonca, the World Organisation of Family Doctors.
The Time to Live Report calls for doctors to adopt guidelines and re-prioritise their approach in COPD management. Over 90% of doctors interviewed as part of the Time to Live Report agreed that reducing exacerbations ("lung attacks") in COPD is vital to improve patients' quality of life and 70% think that reducing hospital visits is crucial. (1, 2) However, despite updated guidelines and advances in treatment, a quarter of COPD patients hospitalised with an exacerbation will be dead within a year(3,4), and more than 90% of sufferers report that exacerbations affect their daily life. (5)
Exacerbations are an acute worsening of symptoms, often triggered by a respiratory infection, requiring medical intervention and often hospitalisation. However, while doctors do see the need to reduce exacerbations, when it comes to management strategies for the condition 81% of doctors interviewed for the report still regard every day symptomatic relief as the best treatment option. This suggests that preventing and reducing exacerbations is still not enough of a priority in COPD management.
Dr Alfred Loh, Chief Executive Officer of Wonca comments: "The Time to Live Report demonstrates the need to refocus the way in which clinicians view and treat COPD. The level of care provided to patients with COPD, and the morbidity and mortality associated with the condition, is truly unacceptable. We urgently need to change the prevailing attitude that COPD is a hopeless condition with limited treatment options. Advances in treatment and our ever-increasing understanding of COPD means it is a condition that is both preventable and treatable. The great news is that evidence shows family doctors can make a huge difference to the lives of people with COPD and their families by focussing on reducing the number and severity of exacerbations they have to suffer."
Recommendations on how to treat COPD have been set out in evidence-based guidelines such as those developed by the Global Initiative for Chronic Obstructive Lung Disease (GOLD). (6) The International Primarycare Airways Group Handbook (IPAG) Handbook, officially launched in May 2005 at the Wonca Asia-Pacific Regional Conference in Kyoto, Japan, also provides family doctors with practical guidelines on the medicine-based management of COPD. Despite acknowledgment by clinical bodies that exacerbations are a key treatment goal for COPD, results from a recent survey included in the Time to Live Report demonstrated a considerable difference between targets set out in guidelines and clinical practice.
- 90% of doctors believe reducing exacerbations is vital to improve patient's HRQoL
- 89% agree prevention of exacerbations is key when considering choice of therapy
- 89% agree slowing down disease progression should be the primary goal in COPD
- 81% still regard symptomatic relief as the best option for treating COPD
- One quarter of GPs are unaware of the new guidelines
- 66% of doctors still believe patients must accept that their disease can not be managed. (2)
Dr John Haughney, GP in Glasgow, Scotland, Chairman of the UK General Practice Airways Group and co-author of the Time to Live Report, comments: "Preventing exacerbations is identified as a key goal for the effective management of COPD, yet the Time to Live Report reveals there is still confusion about the principal aims of COPD management. Due to outdated beliefs about the benefits of therapeutic interventions in COPD and a failure to implement best practice, many patients continue to suffer unnecessarily. Reducing the frequency and severity of exacerbations, and treating them aggressively and effectively, is even more important than long term symptom management, and should be the main focus of treatment if we are to reduce the burden imposed on patients and healthcare resources by COPD."
Professor Thys van der Molen, GP, Professor at the Department of General Practice at the University of Groningen, Professor of Primary Care Respiratory Medicine at the University of Aberdeen and Time to Live Report co-author adds: "When considering therapeutic options, doctors should focus on ensuring they recommend treatments based on their ability to reduce the burden of exacerbations as well as providing symptomatic relief. This strategy will eventually lead to a better outcome since exacerbations have a negative influence on patients' quality of life that can last up to 6 months after the exacerbation. If we want to put the patient first, and give them the best possible outcome, we must ensure we tackle both aspects of this debilitating condition rather than just symptoms alone."
Traditional COPD therapies previously recommended for the treatment of COPD, such as short-acting bronchodilators, help to relieve acute symptoms. Recent evidence has shown treatment with both a long-acting bronchodilator and an inhaled corticosteroid - in particular when individual components are used in combination - not only provides symptomatic relief, but also significantly reduces the frequency and severity of COPD exacerbations, events which are known to be a major contributor towards worsening of lung function. (7, 8)
Source: Eurekalert & othersLast reviewed: By John M. Grohol, Psy.D. on 21 Feb 2009
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