Practice Support Program in COPD: South Okanagan Project COPD CARE Algorithm South Okanagan, Interior Health Patricia Rattee RRT, CRE Shannon Walker MD, FRCPC Respirology

2  COPD is under-diagnosed.  COPD is a chronic progressive respiratory disease for which guidelines recommend a chronic disease management approach through a multi-disciplinary team and patient self-management endpoints.  GPs may not have the time nor skills to promote self- management disciplines to their patients with COPD.  Tools currently exist for AECOPD discharge planning but not for early identification or management of the COPD outpatient. Why did we do this project?

3  To promote early diagnosis of COPD in the community with a case finding approach and registry  To improve the care pathway of patients with COPD or suspected COPD through the GPs office  Develop relationships and care plans amongst family physicians, patients, specialists and acute care / community services  To promote and encourage optimal management of COPD patients according to national Canadian Thoracic Society COPD guidelines What do we hope to achieve?

4 VISIT 1: Patient Registry Burden of COPD Identification of Persons at Risk VISIT 2: Screening of Persons at Risk Smoking cessation COPD-6 or Spirometry VISIT 3: Confirmation Spirometry interpretation Assessment of level of disability VISIT 4: Management CTS guidelines for pharmacologic and non-pharmacologic treatment, ACTION PLAN VISIT 5+: Continuing Care Follow up, Rehab, Co-morbidities, End of Life 5 step OFFICE APPROACH

5  BE AWARE OF THE BURDEN OF COPD in Canada and world-wide  WHO IS AT RISK? › Formulate a patient registry › Identify smokers and ex-smokers in the practice › Have smoking cessation tools and contacts at hand › Bring patient at risk back for screening Visit 1: Identification

6

7  To screen for COPD, airflow obstruction not fully responsive to BD needs to be demonstrated  Physical exam, Xray, nor smoking history alone confirms the diagnosis  COPD-6 is useful office tool for screening in suspected patients  Differentiate from other airway diseases, and other causes of SOBOE Visit 2: Screening

8

9  Does spirometry confirm fixed airflow obstruction post- bronchodilator?  Is the patient still smoking?  How severe is the FEV1?  How severe are symptoms and/or disability? Visit 3: Confirmation of COPD and Assessment of Severity

10

11  Lung function  Level of symptomatology  Level of disability  Co-morbidities  Exacerbations and hospitalizations  Systemic effects What constitutes “Severity”?

12 1.Do they have COPD? 2.Are they still smoking?* 3.Do they have symptoms? 4.Have they had an exacerbation in the past year? 5.Answers to the above determines the starting point for the management of COPD… 6.CTS management guidelines Visit 4: Management of COPD

13 Comprehensive Management of COPD GOLD stages (FEV1) I (>80%) II (50-80%) III (30-50%) IV (<30%)

14

15

16 Optimal Pharmacotherapy

17

18  Prevention and Treatment of AECOPD  Management of progressive symptoms  Compliance and Medication Side-effects  Pulmonary Rehab  Respiratory Education  Patient Self-management and Action Plans  Re-assessment of lung function  Management of Co-morbidities  End of Life Care Visit 5+: Continuing COPD Care and Tools COPD CARE PROGRAM

19

20 Questions ???

21 AECOPD Management