Exercise for patients with COPD: an integral yet underutilized intervention.

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.

Primary care perspective on chronic obstructive pulmonary disease management.

Chronic obstructive pulmonary disease (COPD), which affects > 24 million adults in the United States, is expected to become the third leading cause of mortality by 2030. Because primary care physicians (PCPs) form the frontline in treating patients with COPD, it is vital for them to comprehend the key issues associated with COPD management. The initial step is identifying the "right patient" by making a correct diagnosis, which should involve a targeted respiratory history, physical examination, and spirometry. Following diagnosis, the patient should be treated for the "right reason," with the "right therapy." The right reasons for treating patients diagnosed with COPD include symptom relief, prevention of exacerbations and disease progression, and reduction of mortality. Treatment of patients with COPD through smoking cessation and appropriate medications can help achieve these goals. A range of therapies, such as bronchodilators (ß2-agonists and anticholinergics) and inhaled corticosteroids are available for disease management. Tailoring treatment plans, which include both pharmacological and nonpharmacological therapies, to suit each patient's needs will enable PCPs to provide patients with optimal disease control and treat "the right patient for the right reason with the right therapy."

Office management of COPD in primary care: a 2009 clinical update.

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.

Improving exercise tolerance and quality of life in patients with chronic obstructive pulmonary disease.

Chronic obstructive pulmonary disease (COPD) is the fourth leading cause of mortality in the United States. Its symptoms, comorbidities, and sequelae also result in high morbidity and healthcare costs. The impact of progressive dyspnea, fatigue, exercise intolerance, and recurrent exacerbations in patients with COPD can be devastating to their quality of life. Un-addressed, these symptoms often result in depression and social isolation, causing further decline in exercise tolerance and functional performance. Assessing the physiologic, pharmacologic, and psychosocial factors that influence these elements can be challenging in the primary care setting. The present article describes a practical approach to assess functional performance and outlines pharmacologic and nonpharmacologic strategies-particularly self-management education and pulmonary rehabilitation-to improve quality of life indicators.

The impact of exercise on activities of daily living and quality of life: a primary care physician's perspective.

Evaluation of the environment of patients is an important function of the primary care physician and assists the caregiver in providing an improved quality of life for one's patients. In addition to data collection and therapy, assessment of both the basic and instrumental activities of daily living is a primary concern, especially in patients with chronic diseases such as chronic obstructive pulmonary disease. This article presents the perspective and observation of a primary care physician's management of chronic obstructive pulmonary disease and will give examples of how combined pulmonary rehabilitation and medication improved the quality of life for three patients and show how activities of daily living and quality of life may be seen as a continuum in chronic obstructive pulmonary disease.