Preventive Care Needed in Treating COPD Patients
Although chronic obstructive pulmonary disease (COPD) is highly preventable, it still claims more than 119,000 deaths every year in the U.S. and is on track to move from the fourth leading cause of death today to the third leading cause within 10 years
Those stats can change, of course, if new strategies for treating and preventing COPD can be devised. Time is of the essence here, because we currently have 12 million known COPDers in this country and another estimated 12 million who have the disease and don't know it.
Especially important in the treatment mode is dealing with patients with exacerbations. Of interest to caregivers is the fact the most commonly detected trigger for exacerbations is airway infection caused by viruses or bacteria, according to Tom Wilkinson and J.A. Wedzicha in an article in the International Journal of COPD.
Recognizing the importance of treating the disease well is evidenced by the sobering statistic that the survival rate of patients hospitalized with acute exacerbation of COPD is not good, with 50 percent of the patients dying within three years, according to Medical News Today.
Patients hospitalized with COPD do better when the receive antibiotics without delay, according to researcher Michael B. Rothberg, MD, of Baystate Medical Center, Springfield, Mass.
This is not to say all patients will benefit from antibiotics, he added. "At present, we think that only about half of COPD exacerbations are caused by infection, so probably only half of patients can benefit from this therapy. The problem is that we don't know which half."
Researchers in his study looked at the outcomes of 85,000 patients in 413 hospitals in the U.S. from January 2006 to December 2007 and found 79 percent of the patients received antibiotics for at least two days.
Fewer of the patients started on antibiotic therapy in the first two days needed to be placed on a ventilator or died.
While antibiotics can be used to treat bacterial infections, viral infections require options like pneumonia or flu shots. It's not easy to separate one infection from the other without extensive lab tests.
Some clues to a patient's condition might be found easily, according to a study by Robert A. Stockley, MD, of the University of Birmingham, published in an article in Pulmonary Reviews.Com.
His research in Birmingham, England, found it is possible to tell which COPD patients have a respiratory infection requiring an antibiotic just by looking at the color of the patient's sputum.
Green or yellow indicates an infection is probably present, he explained. White or clear sputum suggests the patient does not have a bacterial infection. The two organisms most often found in the study were were Haemophilus influenzae and H. parainfluenzae.
Based on his findings, he recommended the use of antibiotics with acute COPD exacerbations for those with green or yellow sputum.
He noted the sputum colors can be used by patients themselves to self-monitor their conditions at home during follow-up therapy.
In light of exacerbation prevention, it is important to look at some of the variables involved in long-term care. Modifiable risk factors include: active smoking, low rates of involvement in rehab programs, inappropriate use of oxygen therapy, and poor inhaler technique. Improvements in any area spell positive results.
It is important to consider COPD exacerbations are expensive and may signal the individual is at risk for further exacerbations, noted Wilkinson and Wedzicha.
An ounce of prevention is still worth a pound of cure in the COPD arena. We urgently need to change the prevailing attitude that COPD is a hopeless condition with limited options, according to Alfred Loh, MD, chief executive of the World Organization of Family Doctors.