Multidisciplinary Care of the Patient with Chronic Obstructive Pulmonary Disease

Abstract

The National Emphysema Treatment Trial used a multidisciplinary team approach to implement the maximum medical care protocol, including adjustment of medications and outpatient pulmonary rehabilitation for all patients and nutritional and psychological counseling as needed. This article discusses the benefits of such an approach in the care of the patient with chronic obstructive pulmonary disease. Team member roles complement each other and contribute to the goal of providing the highest-quality medical care. The primary focus of the team is to reinforce the medical plan and to provide patient education and support. This article reviews the elements of the initial patient assessment and the functional and nutritional assessment. Patient education focuses on medication use, recognition and management of chronic obstructive pulmonary disease exacerbation symptoms, smoking cessation, advance directives, and travel.

Inflammation in COPD and New Drug Strategies

“…There is compelling evidence of the role of systemic inflammation in decreasing muscle mass, weakness and loss of function in COPD patients 182 and tests to detect early markers of muscle involvement may be clinically beneficial to target patients of greatest risk of losing muscle mass with early rehabilitation interventions 183 . Targeting patients with multiple co-morbidities and provision of early pulmonary rehabilitation and physiotherapy can have a major impact on improving morbidity and decreasing mortality 184 .…”

Healthy lifestyle interventions in general practice

“…11,17,19 This assessment should consist of a medical history, clinical examination and special investigations (as required). The aims of this assessment are:…”

“…9,17,19,19 The general practitioner is uniquely positioned to address this first component of a lifestyle intervention programme for these patients.…”

“…11 This intervention should not only focus on improving knowledge but should primarily be aimed at teaching skills. 17 The content of an educational programme can vary but would normally include the following topics 11,19 :…”

“…• A strong message from the medical staff including the general practitioner to stop smoking 4,19 • Assessing readiness to stop smoking 19 • Identifying both motivating factors and barriers to stopping 19 • Acknowledging the difficulty in stopping 19 • Providing educational information that describes the specific benefits of stopping 9 • Use of self-help books, support groups, chat rooms. 19 Examples of two self-help programmes in South Africa are:…”