“Healthy Lungs – Never More Important”

Chronic obstructive pulmonary disease (COPD) is the third leading cause of death worldwide, according to the World Health Organization (WHO) and accounted for 3.23 million deaths in 2019. Most of these deaths were reported from low- and middle-income countries.

COPD patients are prone to exacerbations leading to rapid decline in lung function, increased hospitalizations, reduced quality of life and higher mortality. Smoking is well-documented as a risk factor for the disease as well as exacerbations; other risk factors include exposure to air pollution, dust, fumes, secondhand smoke, poor compliance, high treatment costs. To this list can also be added, therapeutic or clinical inertia, defined as “failure to escalate or initiate adequate therapy when treatment goals are not met”, resulting in inadequately or suboptimally managed episodes of acute exacerbations.

Recognizing the role of therapeutic inertia in acute exacerbations of COPD, a panel of five clinicians from the United Kingdom (UK) have developed four action points (as below) to reduce the risk of exacerbations.¹

• “Act on hospital discharge and follow-up”: Patients should be reviewed within 30 days of every exacerbation (which needs to be treated with oral steroids, antibiotics, or hospitalization) to address modifiable risk factors, optimize non-pharmacological measures, and evaluate pharmacological therapy.
• “Act on recognition, reporting and recording of every exacerbation”: Physicians should be able to recognize COPD exacerbations and refer them as appropriate. The episode should be accurately documented in the medical records of the patient. Moreover, they should educate patients to recognize exacerbations and report them.
• “Act on predictors of risk for exacerbations”: Physicians should be more proactive and assess risk factors, disease status at the first opportunity after the diagnosis and then every year.
• Visiting a hospital during an exacerbation provides a “window of opportunity” to reduce the risk of further exacerbations. A complete review of treatment and escalation of medication, where indicated is imperative to improve patient outcomes after hospital discharge.

The study authors write, “These action points should be a fundamental part of clinical practice to determine if a change in management is necessary to reduce the risk of exacerbations. Policymakers should use these action points to develop systems and initiatives that reduce the risk of further exacerbations.”

COPD is a preventable and treatable disease, a fact accepted and incorporated by the Global Initiative for Chronic Obstructive Lung Disease (GOLD) committee in their definition of COPD. However, the majority of COPD cases are diagnosed at an advanced stage, where the lung has already been damaged to quite an extent. Hence, it continues to be an important cause of death globally.

The authors have also called for a change of approach in managing COPD patients along the lines of management of heart diseases, diabetes, hypertension, where the focus has now shifted to prevention and self-management. Acting on risk factors, early diagnosis, right treatment, pulmonary rehabilitation and educating patients not only about the disease but also self-management should help to reduce the frequency of exacerbations. 

“Healthy Lungs – Never More Important” is the theme of the World COPD Day this year  and it is never more appropriate than now, when Covid-19 continues to rampage across the world and SARS-CoV-2 keeps threatening to come up with a new avatar.

Reference

1. Singh D, et al. Overcoming therapeutic inertia to reduce the risk of COPD exacerbations: four action points for healthcare professionals. Int J Chron Obstruct Pulmon Dis. 2021 Nov 1;16:3009-3016. doi: 10.2147/COPD.S329316.