1. Are patients with chronic diseases a new challenge to general practice? Do patients with severe COPD need 6-monthly check-ups at their general practitioner? Why do patients with severe chronic obstructive pulmonary disease (COPD) need 6-monthly check-ups at their general practitioner? Jesper Lykkegaard Research Unit of General Practice, Institute of Public Health, University of Southern Denmark jlykkegaard@health.sdu.dkjlykkegaard@health.sdu.dk. 1Jesper Lykkegaard

2. Are patients with chronic diseases a new challenge to general practice? Do patients with severe COPD need 6-monthly check-ups at their general practitioner? 430,000 persons in Denmark have COPD 2Jesper Lykkegaard 9.5% of the adult population Løkke A, 2007 at least 1 hospitalization FEV1 35% on average 10 patients per GP 25,000 have severe COPD:

3. Are patients with chronic diseases a new challenge to general practice? Do patients with severe COPD need 6-monthly check-ups at their general practitioner? Jesper Lykkegaard Recommendations: Vaccinations 3 Rehabilitation: Exercise Self management Smoking cessation Dietary advice 6-monthly check-ups COPD patientMaleFemale Visits daytime 8 8 Telephone 9 12 Visits after hours 2 3 Contacts per year 19 23 Bilde L, 2003 6-monthly check-ups ?

4. Are patients with chronic diseases a new challenge to general practice? Do patients with severe COPD need 6-monthly check-ups at their general practitioner? Jesper Lykkegaard 1 year mortality 35% - 30% cardiovascular disease - 8% pulmonary cancer - 40% COPD - 22% other causes Chatila W M, 2008 Eriksen N, 2003 4

5. Are patients with chronic diseases a new challenge to general practice? Do patients with severe COPD need 6-monthly check-ups at their general practitioner? Jesper Lykkegaard 10 % mortality during admission Eriksen N, 2003 5

6. Are patients with chronic diseases a new challenge to general practice? Do patients with severe COPD need 6-monthly check-ups at their general practitioner? Jesper Lykkegaard Cause of death based on autopsy: 37% cardiac failure 28% pneumonia 21% pulmonary embolism 58% chronic heart failure 14% COPD Zvezdin B, 2009 6

7. Are patients with chronic diseases a new challenge to general practice? Do patients with severe COPD need 6-monthly check-ups at their general practitioner? Jesper Lykkegaard Screening the patients: 25 % Pulmonary embolism 45 % Major depression 68 % Osteoporosis Tillie-Leblond I, 2006 Jørgensen N R, 2007 Ng T P et al, 2007 60 % ECG signs of Right ventricular overload 21 % ECG signs of IHD Antonelli et al, 1997 …..all diagnoses other than pregnancy-related diseases Bilde L, 2007 7

8. Are patients with chronic diseases a new challenge to general practice? Do patients with severe COPD need 6-monthly check-ups at their general practitioner? Jesper Lykkegaard Why comorbidity? Smoking Age Corticosteroids Hypoxia Immobilisation 8 COPD predicts: Depression Cardiovascular disease Pulmonary cancer Osteoporosis Mannino DM et al, 2003 Jørgensen NR et al, 2006 Truelsen T et al, 2001 Van den Bemt L et al, 2009 Inflammation Barnes PJ et al, 2009

9. Are patients with chronic diseases a new challenge to general practice? Do patients with severe COPD need 6-monthly check-ups at their general practitioner? Jesper Lykkegaard Why do patients with severe COPD need 6 monthly check-ups at their general practitioner? 9

10. Are patients with chronic diseases a new challenge to general practice? Do patients with severe COPD need 6-monthly check-ups at their general practitioner? Jesper Lykkegaard10 Bad prognosis Critical - Hidden - Treatable Comorbidities Depression Cardiovascular Cancer Osteoporosis

11. Are patients with chronic diseases a new challenge to general practice? Do patients with severe COPD need 6-monthly check-ups at their general practitioner? Jesper Lykkegaard Thank you for your attention 11