COPD Management & Care Strategies for Better Patient Outcomes

Introduction

Chronic Obstructive Pulmonary Disease (COPD) is a progressive respiratory condition that significantly impacts patients’ quality of life and is a leading cause of morbidity and mortality worldwide. Characterised by persistent airflow limitation, COPD often leads to frequent hospitalisations, emotional distress, and physical decline, especially in its advanced stages. Effective management of COPD requires more than symptom control; it demands early detection, timely interventions, patient-centred care, and appropriate end-of-life planning. The selected articles in this review explore different dimensions of COPD care, ranging from early disease identification and risk factor management to palliative care integration and advanced therapeutic approaches. They collectively highlight the importance of early intervention, clinician-patient communication, and comprehensive strategies to improve both life expectancy and quality of life for individuals with COPD. By examining current evidence, this assignment seeks to provide insights into best practices and evolving approaches in COPD management, with a focus on enhancing patient outcomes.

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Article 1

Iyer, A. S., Sullivan, D. R., Lindell, K. O., & Reinke, L. F. (2022). The Role of Palliative Care in COPD. Chest, 161(5), 1250–1262. https://doi.org/10.1016/j.chest.2021.10.032

Figure 1: The care of palliative for declining illness in the cases of COPD

This paper aims to present an appraisal of the work done and delineate the significance of the placement of palliative care in the COPD care plan early enough in the COPD process. COPD is one of the main causes of mortality in the United States It is characterized by worsening respiratory function, going hand in hand with depression, anxiety, and frequent hospitalizations; therefore it affects the patient’s quality of life significantly. Yet, there is a demand for it, and even in the case of COPD, which is considered one of the most treatable, patients receive palliative care in the final stages only (Iyer et al. 2022). This review focuses on the timely integration of specialist and primary palliative care into disease management as a way of enhancing patients’ quality of life and their end-of-life care. As far as the topic of this study is concerned, this work emphasizes the idea that palliative care should be an ongoing part of the intermediate and end-stage COPD treatment process rather than a special additional procedure for the final stages. Strength Following the study, this paper seeks to advocate for a change in clinical practice through the implementation of early palliative care especially with the help of National Consensus Project Guidelines. Thus, the study offers a realistic approach that can reduce physical, emotional, and psychological tolls of COPD while improving both, the patient’s and the carer’s experiences from the condition at every phase.

Article 2

Yang, W., Li, F., Li, C., Meng, J., & Wang, Y. (2021). Focus on Early COPD: Definition and Early Lung Development. International journal of chronic obstructive pulmonary disease, 16, 3217–3228. https://doi.org/10.2147/COPD.S338359

Figure 2: The trajectory phases of lung functions and several stages of the risk

This paper aims to elucidate the nature of the so-called early COPD with regard to the existing literature that focuses on the early stage of Chronic Obstructive Pulmonary Disease. COPD is a widespread disease, which claimed millions of people’s lives and has not received much attention in treatment and prevention sections. The idea of early COPD is rather old but the understanding of it remains rather limited; particularly, many workers in the field of medicine tend to confuse early COPD with COPD mild. This review is targeted to explain the meaning of early COPD and for the elaboration of the developmental process of lung function. This study also highlighted that the absence of any indications the patient who has been diagnosed with COPD displays the reduction of the qualities of lung function in contrast to the healthy person. This study has also emphasized the necessity of an evident and comprehensive description to find out the group that can be considered for lung improvement which is also a dynamic procedure affected by the responsible factors such as air pollution and smoking habits (Yang et al. 2021). It demands enhanced attention for the risk factors experienced by the children and prenatal stage as they are also affected by parental smoking, preterm birth the several respiratory problems. This study is also relevant to the topic as this has emphasized the significance of early intervention which can reduce the effects of COPD. The strength point of this study is to offer the complete and efficient approach that helps in the understanding of threats that have occurred due to the COPD. by recognizing the life factors this study has represented the way which can deteriorate the morbidity rates of COPD and develop the consequences.

Article 3

Mitzel, H., Brown, D., Thomas, M., Curl, B., Wild, M., Kelsch, A., Muskrat, J., Hossain, A., Ryan, K., Babalola, O., Burgard, M., & Mehedi, M. (2022). Patient-Centered Discussion on End-of-Life Care for Patients with Advanced COPD. Medicina (Kaunas, Lithuania), 58(2), 254. https://doi.org/10.3390/medicina58020254

The research conducted presents a breadth of findings that includes a description of the difficulties and intricacies in addressing COPD, especially during the late stages of the illness. Chronic obstructive pulmonary disease is a progressive, non-reversible illness that impacts millions globally and ranks as the third leading killer; however, many patients receive insufficient care towards their final days. In cases of COPD, the patient may experience a deterioration of the disease in terms of breathing and certain conditions can make the progress toward the end of life quite uncontrolled (Mitzel et al. 2022). Thus, the present work underlines the importance of patient-clinician communication with an emphasis on this study hence, providing patients with advanced COPD with a broader perspective on the remaining life might be beneficial for them. The paper briefly reviews the existing knowledge on COPD and the current therapeutic methods to address this disabling disease, stressing patient-centered care. This research also captures the potential trajectories of COPD and the importance, and understanding of the patient’s need for end-of-life care communication. This has also highlighted the changeable nature of the development of COPD with the discussion related to the important function of compassion in this type of condition. This has also focused on the significance of the care for those patients and the requirements of the clinicians to be involved in the open discussion related to improving the qualities of life. 

Article 4

Minami, K., Unozawa, C., Matsunaga, A., & Kamei, T. (2024). End-of-Life Care for People with Chronic Obstructive Pulmonary Disease A Scoping Review Protocol.

This study has presented the following outlines as the methodology of this study as a scoping review that aimed at identifying concepts, sources, and types of evidence regarding EoLC for COPD Patients. Similar to most chronic ongoing inflammatory diseases, COPD appears to follow a general illness trajectory, although patients with the disease experience different and severe degrees of suffering toward the terminal stage. An understanding of the patterns of these diseases and how EOLC can be given in such cases is, therefore, very important in enhancing patient care. The aim of this systematic review therefore is to systematically review the current literature on EOLC interventions available for patients with COPD according to the Joanna Briggs Institute reviewer’s manual and with reference to the PRISMA-ScR tool (Minami et al. 2024). The review will comprise both quantitative and qualitative research articles from databases like CENTRAL, PubMed, CINAHL, Embase, PsycINFO, and Google Scholar restricting articles of a specific year. The manner in which the findings will be analyzed will be by giving a narrative account of the study, looking at the possible inconsistencies and biases in the available evidence. This study is also relevant to the topic as this study has enhanced the understanding of the interventions which can be processed to fulfill the requirements of affected patients by COPD. By recognizing the limitations this review has the efficiency to notify about the upcoming research and develop the practices of the experts. By improving the practices of the healthcare providers the quality of life of the patients can be improved has also emphasized in this study.

Article 5

Ross, J. C., Estépar, R. S. J., Ash, S., Pistenmaa, C., Han, M., Bhatt, S. P., ... & Diaz, A. A. (2024). Dysanapsis is differentially related to lung function trajectories with distinct structural and functional patterns in COPD and variable risk for adverse outcomes. EClinicalMedicine, 68.

This paper aims to establish how dysanapsis; a state in which the size of the small airways’ lumens corresponds to but is smaller than the lung volume, impacts lung function courses that will potentially result in ‘Chronic Obstructive Pulmonary Disease’ as well as other complications including mortality and exacerbations. It must be noted that the conventional measures of lung function and their abnormal trajectories are associated with higher rates of COPD and premature mortality; however, the role of dysanapsis in modifying these trajectories has hardly been broached. To fill this gap, the study used Bayesian trajectory analysis on the COPD Gene Study cohort, which obtained baseline data between 2007 and 2012. The analysis distinguished seven separate lung function trends including supranormal trend, basic trend, and five trends with elevated threat of mortality and ECOPD (Ross et al. 2024). Dysnapsis was quantified with an airway lumen-to-lung volume ratio derived from preoperative CT scans. A lower ratio of the variables was also statistically significantly related to the higher value of trajectory revealing the subject’s higher risks of mortality and ECOPD. These trajectories were also defined by the heterogeneity in the nature of FEV1 and FVC reductions and associated COPD patterns by quantitative computed tomography. Regarding the topic of this study it is essential to highlight the importance of early recognition of the people with the at-risk lung function trajectories and using the patient management approaches that can change the disease course and thus enhance the quality of the patient functioning as well as the end-of-life care. Therefore, the strength of this study lies in the utilization of multiple assessment methods based on CT-assessed dysnapsis, spirometry, and Bayesian trajectory analysis to better understand the nature of COPD progression. By finding out certain specific functional decline patterns associated with unfavorable prognosis, the study offers useful applicability for timely diagnosis and treatment that can substantially enhance the patient’s quality of life for those at risk of developing severe COPD and having a poor quality of terminal period.

Reference List

Journals

Iyer, A. S., Sullivan, D. R., Lindell, K. O., & Reinke, L. F. (2022). The Role of Palliative Care in COPD. Chest, 161(5), 1250–1262. https://doi.org/10.1016/j.chest.2021.10.032 [Retrieved from: https://doi.org/10.1016/j.chest.2021.10.032] [Retrieved on: 1.08.2024]

Minami, K., Unozawa, C., Matsunaga, A., & Kamei, T. (2024). End-of-Life Care for People with Chronic Obstructive Pulmonary Disease A Scoping Review Protocol. [Retrieved from: https://www.researchsquare.com/article/rs-3778507/latest.pdf] [Retrieved on: 1.08.2024]

Mitzel, H., Brown, D., Thomas, M., Curl, B., Wild, M., Kelsch, A., Muskrat, J., Hossain, A., Ryan, K., Babalola, O., Burgard, M., & Mehedi, M. (2022). Patient-Centered Discussion on End-of-Life Care for Patients with Advanced COPD. Medicina (Kaunas, Lithuania), 58(2), 254. https://doi.org/10.3390/medicina58020254 [Retrieved from: https://doi.org/10.3390/medicina58020254] [Retrieved on: 1.08.2024]

Ross, J. C., Estépar, R. S. J., Ash, S., Pistenmaa, C., Han, M., Bhatt, S. P., ... & Diaz, A. A. (2024). Dysanapsis is differentially related to lung function trajectories with distinct structural and functional patterns in COPD and variable risk for adverse outcomes. EClinicalMedicine, 68. [Retrieved from: https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(23)00585-0/fulltext] [Retrieved on: 1.08.2024]

Yang, W., Li, F., Li, C., Meng, J., & Wang, Y. (2021). Focus on Early COPD: Definition and Early Lung Development. International journal of chronic obstructive pulmonary disease, 16, 3217–3228. https://doi.org/10.2147/COPD.S338359 [Retrieved from: https://doi.org/10.2147/COPD.S338359] [Retrieved on: 1.08.2024]