Patient education is the key to enhancing treatment of COPD and getting patients to adhere to their recommended regimen.
Optimal management of chronic obstructive pulmonary disease (COPD) requires close cooperation of the patient, physician, clinical staff and caregivers to develop a program the patient can adhere to with relative ease.
“Patients need to be provided with adequate training and education on effective inhaler technique and to be actively encouraged to participate in the management of their disease,” Barbara Yawn, MD, adjunct professor of family and community health at the University of Minnesota, told Medical Economics. “The goal is to have the patient go from a passive recipient of instructions to an informed, activated participant in his or her own care.”
COPD education for patients and their families and caregivers should emphasize the importance of adhering to the treatment plan as up to 60% of patients with COPD are non-compliant, said Yawn. Patient education should include information on how to avoid the risk factors of disease progression and exacerbations of COPD, including avoidance of tobacco smoke, occupational dust and chemicals, indoor/outdoor air pollution and bacterial/viral infections.
“All primary care physicians should be actively involved in providing smoking cessation support to smokers,” said Yawn, noting that the majority of COPD patients contact their primary care physician first for help in smoking cessation. Both physicians and nurse practitioners can provide follow-up support, education and counselling. Their participation in smoking cessation programs has been shown to have a positive influence on patient compliance, she said.
Pulmonary rehabilitation should be made available to all COPD patients, who should be encouraged to increase their physical activity. Primary care physicians need to know a patient’s baseline activity level. “Ask if the patient can walk around the block or up a flight of stairs, and keep up with adults of the same age. Does the patient have shortness of breath while performing daily activities?” asked Yawn. The answers should be documented in the patient’s medical record.
Many patients report that they can perform usual activities, but on careful questioning, they may admit that they are much more limited than they used to be. It is also important to ask about exposure to noxious substances other than tobacco smoke at work or home because particulates from large-scale baking or those produced by biomass fuels can cause COPD in nonsmokers.
Unlike heart disease, where a patient with chest pain is told to stop exercising, “for patients with lung disease who are short of breath, tell them to keeping going. They need to push dyspnea a little,” said Yawn. “If the patient can’t get out to the mailbox, make that an activity goal.”
Inhaler technique is critical as well. Almost all patients with asthma or COPD use their inhalers incorrectly, depending on the type of inhaler and method of evaluation. “Inhaler use can be a complex procedure, and all patients should receive clear instruction and training on the correct use of their inhaler. These instructions should be reinforced and inhaler technique demonstrated by the patient to their physician or nurse at each follow-up visit,” said Yawn.
The COPD Assessment Test, filled out in the physician’s waiting room, can provide information on how many symptoms a patient is having. “Check the score against previous tests and use the data to start a discussion on adherence,” she said. It can also be a tool to help clinicians remember what questions to ask to enhance adherence.