Exercise for Patients With COPD: An Integral Yet Underutilized Intervention
exercise; chronic obstructive pulmonary disease; management; Orthopedics; General & Internal Medicine; rehabilitation; Sport Sciences; lung; obstructive pulmonary-disease; pulmonary; public-health; physical-activity; american-heart-association; college; general-practice; hyperinflation; rehabilitation program; respiratory society; sports-medicine
Chronic obstructive pulmonary disease (COPD) was the third leading cause of mortality in the United States in 2009 and accounts for millions of dollars in health care expenses annually. It is characterized by slow declines in functional ability and exercise tolerance, which are strongly predictive of poor health-related quality of life and survival. The cycle of physical, social, and psychosocial consequences of COPD is more easily prevented than remedied; therefore, maintaining baseline respiratory function is a key goal of early treatment. Although medical management of COPD is generally well understood and implemented by most primary care physicians, multidisciplinary approaches that include nonpharmacologic modalities (eg, exercise training) are not often used. Exercise training can alleviate dyspnea and improve exercise tolerance and health-related quality of life in patients with mild-to-severe COPD. Pulmonary rehabilitation, which includes exercise training, nutritional and psychological counseling, and patient education, is an important component of COPD treatment and management programs, and is currently underutilized in the United States. This article addresses the role of exercise as part of a multidisciplinary approach to the management of COPD, especially with regard to pulmonary rehabilitation.
Butts J F; Belfer M H; Gebke K B
Physician and Sportsmedicine
2013
2013-02
Journal Article or Conference Abstract Publication
<a href="http://doi.org/10.3810/psm.2013.02.1999" target="_blank" rel="noreferrer noopener">10.3810/psm.2013.02.1999</a>
Office Management of COPD in Primary Care: A 2009 Clinical Update
chronic obstructive pulmonary disease; spirometry; asthma; General & Internal Medicine; risk-factors; randomized; follow-up; controlled-trial; double-blind; obstructive pulmonary-disease; questionnaire; differentiating copd; dyspnea; receptor partial agonist; smoking-cessation; sustained-release bupropion; symptom-based; tobacco smoking
Primary care physicians (PCPs) usually are the first to diagnose and care for patients with chronic obstructive pulmonary disease (COPD). This article discusses key teaching points of recently published guidelines for PCPs and the common challenges of treating COPD patients in a primary care setting, and clarifies common misconceptions. First, PCPs should choose one of the published screening tools to assess for COPD. Spirometry is a useful tool to confirm the diagnosis of COPD to distinguish COPD from asthma, to stage the disease for determining treatment, and it can help with smoking cessation efforts. Chest radiographs do not help to diagnose COPD but are useful to rule out other causes of dyspnea and cough. Differentiating COPD from asthma is important because it affects treatment decisions and prognosis. Second, the goals of COPD treatment are to relieve symptoms, improve exercise tolerance, prevent exacerbations, and improve quality (although not necessarily extend quantity) of life. Chronic obstructive pulmonary disease can be treated at any stage, and the treatments are adjusted in a stepwise approach based on disease severity. Third, as part of the long-term management of COPD, smoking cessation should be discussed at every visit, and inhaler technique should be reviewed at regular intervals. Chronic obstructive pulmonary disease patients should also receive the recommended influenza and pneumococcal vaccinations. Primary care physicians are in a unique position to identify COPD patients early, to implement primary and secondary preventive measures, and to provide care that addresses the full spectrum of COPD and its comorbidities.
Belfer M H
Postgraduate Medicine
2009
2009-07
Journal Article or Conference Abstract Publication
<a href="http://doi.org/10.3810/pgm.2009.07.2034" target="_blank" rel="noreferrer noopener">10.3810/pgm.2009.07.2034</a>