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Optimizing nonpharmacological management following an acute exacerbation of chronic obstructive pulmonary disease

Authors Harrison SL, Goldstein R, Desveaux L, Tulloch V, Brooks D

Received 26 June 2014

Accepted for publication 7 August 2014

Published 29 October 2014 Volume 2014:9(1) Pages 1197—1205

DOI https://doi.org/10.2147/COPD.S41938

Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 2

Editor who approved publication: Dr Richard Russell

Samantha L Harrison,1 Roger Goldstein,1 Laura Desveaux,1 Verity Tulloch,1 Dina Brooks2

1Department of Respiratory Medicine, West Park Healthcare Centre, Toronto, ON, Canada; 2Department of Medicine Physical Therapy, University of Toronto, Toronto, ON, Canada

Abstract: Though the guidelines for the optimal management of chronic obstructive pulmonary disease (COPD) following an acute exacerbation (AE) are well established, issues associated with poor adherence to nonpharmacological interventions such as self-management advice and pulmonary rehabilitation will impact on hospital readmission rates and health care costs. Systems developed for clinically stable patients with COPD may not be sufficient for those who are post-exacerbation. A redesign of the manner in which such interventions are delivered to patients following an AECOPD is necessary. Addressing two or more components of the chronic care model is effective in reducing health care utilization in patients with COPD, with self-management support contributing a key role. By refining self-management support to incorporate the identification and treatment of psychological symptoms and by providing health care professionals adequate time and training to deliver respiratory-specific advice and self-management strategies, adherence to nonpharmacological therapies following an AE may be enhanced. Furthermore, following up patients in their own homes allows for the tailoring of advice and for the delivery of consistent health care messages which may enable knowledge to be retained. By refining the delivery of nonpharmacological therapies following an AECOPD according to components of the chronic care model, adherence may be improved, resulting in better disease management and possibly reducing health care utilization.

Keywords: acute exacerbation, chronic obstructive pulmonary disease, pulmonary rehabilitation, self-management, physical activity, oxygen, adherence, chronic care model

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