In 2012 we received a grant from the Veterans Health Administration
Office of Specialty Care entitled, "Patient-Centered Model for the
Management of Chronic Obstructive Pulmonary Disease." The grant's
goals were to enhance the recognition and diagnosis of COPD and
implement a Patient-Centered Model for the Management of COPD. As
the work on that proposal progressed, we realized that providers
did not have an up-to-date, comprehensive, easily read, "how to"
manual for the management of COPD despite all the advances in COPD
care that have occurred over the past 5 years. Consensus documents
such as the VA-DOD Guidelines were abbreviated summaries that were
rarely used. From those discussions, the concept for this volume, a
COPD Primer, developed. The goal was to develop a practical book
that concisely presented COPD to providers with sufficient
background and explanation of the physiologic and scientific
rationale for various management strategies without becoming an
esoteric academic work. We hope that this COPD Primer has achieved
that goal and will be a useful, practical text for practitioners
and medical trainees alike. The COPD Primer begins with an
examination of what COPD is; it is really a syndrome, a
constellation of historical features and clinical, physiologic, and
radiographic findings. However, those elements come together in
many different ways to create multiple different COPD phenotypes
that are only now being recognized and used to define specific
management strategies. COPD research has progressed beyond the
simple classification of "blue bloaters" and "pink puffers." Next,
the epidemiology and economic consequences of COPD are reviewed.
Bill Eschenbacher presents an approach to the patient with
respiratory symptoms with detailed discussions of pulmonary
function testing and how airflow limitation/obstruction is
identified by spirometry and the use of lung imaging to identify
individuals with COPD. Michael Borchers and Gregory Motz summarize
current evidence implicating genetics, proteolytic imbalance,
oxidative stress, inflammation, occupational and environmental
exposures, and innate and adaptive immune function in the
pathogenesis of COPD and the implication of these findings to
future treatments. The single most important intervention in the
prevention and treatment of COPD is smoking cessation. Shari Altum,
Katherine Butler, and Rachel Juran present a practical approach to
smoking cessation utilizing motivational interviewing in
combination with pharmacologic interventions. Then, they expand
upon these concepts to provide practitioners with convenient,
realistic suggestions to encourage patient self-management in all
aspects of COPD care and overall health. Ahsan Zafar reviews the
natural history, recently described COPD phenotypes, and gender
differences that clearly illustrate the broad spectrum of disease
that comprises the term, COPD. The cover illustration highlights
Dr. Zafar's creative and artistic talents. The extensive
nonpulmonary aspects of COPD are reviewed by Ralph Panos in an
examination of COPD's multi-organ manifestations. Next, the effect
of COPD on sleep and the overlap syndrome, the concurrence of COPD
and obstructive sleep apnea, and its consequences are presented.
Jean Elwing examines the effect of COPD on the pulmonary
vasculature with a detailed discussion of the evaluation and
management of pulmonary hypertension associated with COPD. COPD's
effects on psychosocial functioning and familial interactions are
presented by Mary Panos and Ralph Panos. The focus of the Primer
then shifts from manifestations to treatment with a discussion of
stable COPD management. With the current plethora of devices for
delivering respiratory medications, it is difficult for both
patients and providers to sustain knowledge of their proper use.
Aaron Mulhall presents a practical guide to correct inhaler use
that reviews all the current devices. Folarin Sogbetun then reviews
the management of outpatient COPD exacerbations and Nishant Gupta
discusses the approach to the patient hospitalized with COPD.
Because patients with COPD often see multiple subspecialty
physicians in addition to their primary care providers,
interdisciplinary communication and coordination of care is
essential for their management; Sara Krzywkowski-Mohn reviews the
interactions between primary and specialty care for the patient
with COPD with suggestions for improved communication and care
coordination. Finally, advance care planning including palliative
care and hospice is reviewed with a discussion of how end stage
COPD affects not only the patient but also their family and social
network. This COPD Primer incorporates the knowledge that we have
learned over the past several years during the development and
implementation of a patient-centered model for the management of
COPD. It was written with the explicit goal of assisting both the
practicing provider and medical trainee in the care of patients
with COPD.
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