Management programs help patients learn about disease, improve lives

grandmother and granddaughter
COPD is a major health problem and underdiagnosed. It has surpassed stroke as the third leading cause of death in the United States.

By Nicholas J. Kenyon, M.D. and Samuel Louie, M.D.

COPD is one of the most common lung diseases in the world.  It is caused by smoking and exposure to high levels of environmental pollutants, particularly indoor pollutants.   Emphysema is a term that is understood by many, but patients are less familiar with the term COPD, or Chronic Obstructive Pulmonary Disease, which includes both chronic bronchitis and emphysema.  

Drs. Louie and Kenyon are pulmonologists with UC Davis Medical Group and co-directors of the UC Davis Asthma Network (UCAN).

COPD is a major health problem in the United States and it is underdiagnosed.  It has surpassed stroke as the third leading cause of death in the country, according to the American Lung Association, with nearly one death attributable to COPD every four minutes. In 2009, 133,965 people died of COPD, of which more than half (52.3 percent) were women.

Dealing with an COPD attack

Try to stay calm: excitement will exacerbate an attack. Go immediately to an emergency room or call 911 if the attack worsens despite the use of rescue albuterol, or if any of the following signs and symptoms appear:

  • Too exhausted to speak — a late and dangerous sign suggesting total exhaustion and lack of sleep
  • Grunting sound during exhalations

Treatable and reversible symptoms

It is important to recognize that like asthma, COPD is treatable and the symptoms are reversible. We include COPD within the idea of "ROAD" -- an acronym for Reversible Obstructive Airway Diseases, which includes COPD, asthma, and the asthma-COPD overlap syndrome.

Numerous studies of COPD patients have documented over the past three decades that the life expectancy for patients with COPD has improved dramatically and that many classes of COPD medications improve symptoms and quality of life. Proper assessment by physicians is a must!

The Global Obstructive Lung Disease (GOLD) initiative for COPD has made control of symptoms and risks, including the prevention COPD attacks, a priority. Periodically, an acute syndrome featuring an increase in frequency and severity of cough, sputum production, and, most importantly, shortness of breath lasting more than 2 to 3 days, may unsettle a COPD patient and put them at risk for hospitalization and respiratory failure.   

Team approach

Hospital admissions and readmissions around the country (and at UC Davis Medical Center) for acute exacerbation or attack of COPD have increased, and represent an opportunity for multidisciplinary chronic disease management. A COPD case management team, led by registered Respiratory Care Practitioners in the role of COPD case managers, was instituted March 2012 under the supervision of Dr. Samuel Louie in cooperation with Hospitalists during the patient’s hospital stay for severe attack of COPD. 

More information

For more information or to take an asthma control test, contact ROAD Program Coordinators Claudia Vukovich, RRT, AE-C at 916-734-5676 or page the COPD Case Manager at 916-816-COPD. Or ask your doctor or primary care provider.

Pulmonary Rehabilitation Outpatient Program requires a referral from your doctor or nurse practitioner. Contact Nurse Practitioner Karina Berge, RN for info at 916-734-2264 and ask your doctor.

The primary objective of the UC Davis ROAD Center Quality Improvement Program was to reduce readmission rates for COPD patients, intensify patient education, and streamilne access to primary and subspecialty services.  A COPD case management team directs four inpatient education sessions included anatomy and physiology of the respiratory system, proper inhalation device use, return demonstration, controlled breathing techniques, infection control, referral, medication reconciliation, and referral to services, including pulmonary rehabilitation. 

The COPD Case Manager is an integral member of the Hospitalist team of physicians, rounding on patients and leaving assessments and recommendations in the electronic medical records.  At discharge, each patient was given continued access to the case manager on duty through a telephone pager.   What we recognized at UCDHS was that the COPD patient’s self-determination is vitally linked to competence in self-management of COPD.

Our prior experience in asthma is testimony of our penchant for improving clinical outcomes.  We anticipate our involvement in COPD care will motivate healthcare professionals across different delivery settings within UCDHS and the Primary Care Network to provide healthcare that makes a difference one patient at a time.