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New Tool for COPD

Psychological approach may help physiological reactions.

When the American Medical Group Foundation announced the June 2014 release of Best Practices in Managing Patients with Chronic Obstructive Pulmonary Disease Compendium, it heralded case studies contributed by a collaborative of major medical groups and various practice organizations. The group showcased their COPD chronic care models and interventions toward such common goals as:  early identification and diagnosis of patients at risk for, or currently suffering with symptoms of, COPD; improved medication adherence and compliance; continuity of care across settings and transitions of care; increased ability to self-manage symptoms and disease progression through healthier lifestyles; improved health, well-being and patient satisfaction; and Improved physician/patient relationships.

The importance of COPD interventions are well-understood, given that  COPD is now the third leading cause of death in the US, impacting 15 million Americans, according to CDC statistics. In September, new insights were pumped into the COPD provider pipeline by Duke Medicine when a paper was published in the journal Psychosomatic Medicine suggesting that some of those milestone goals could be achieved more readily with telephone-based coaching geared to help patients with COPD manage stress, practice relaxation and participate in light exercise to boost quality of life as well as improved physical symptoms.

Study Regime
According to information provided by Duke, during the 5-year study, based at Duke University Health System and Ohio State University, 147 COPD patients participated in coping skills training. Psychologists provided scheduled phone sessions, providing patients and caregivers with education about COPD, step-by-step relaxation techniques spanning deep breathing, tensing and releasing muscles, and strategies to manage their reactions to stressful events. A separate group of 151 COPD patients were given phone consultations on medication and nutrition, but they did not learn the coping techniques.

New Tool for COPDThe participants who gained coping skills reported improvements in their overall mental health, decreased depression, anxiety, fatigue and shortness of breath when compared to the control group," according to the Duke Medicine report.

"We need new interventions that address the impact of COPD upon patient-centered outcomes, such as the negative impact of the disease upon a patient's quality of life - not just the impact of the disease upon objective measures of lung function," explained study author Scott Palmer, MD, MHS, an associate professor of pulmonary medicine also directs the pulmonary research program at the Duke Clinical Research Institute and oversees a laboratory of approximately 10 individuals engaged in translational and basic research. 

And while he agrees that COPD cannot be "cured," Palmer said, "... it can be better managed. Patients are primarily concerned about getting the best possible quality of life in the years they have remaining. Our study demonstrated that quality of life -- both physical and psychological -- can be enhanced through the counseling they received."

A New Tool
This behavioral enhancement may be new for many COPD patients, simply by virtue of the fact that "Patients with COPD do not often seek mental health services," according to study co-author James Blumenthal, PhD, a professor of behavioral medicine at Duke. "Given the other issues patients face with this illness, they may not feel as though mental health treatment is a priority. This model offers privacy and minimal inconvenience."

Asked how a psychological approach can help a physiological problem, Palmer told ADVANCE, "For diseases like COPD there is definitely an interrelationship between medical and psychological factors. For example, when a person feels short of breath from COPD, that may make them anxious, which in turn may make them breathe faster, and in the setting of disease like COPD, that might contribute to making them feel even more short of breath. Addressing anxiety can help break the cycle."

Telephonic coaching may be an important new tool in providing care for patients with COPD. "Based on our study, we believe this is a very promising approach," said Palmer.

Valerie Neff Newitt is on staff at ADVANCE. Contact:

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So, what is the 'tool'? Is there a questionnaire or instrument that can be shared for those of us working with this patient population?

Thank you

Essy Moverman,  Pulmonary Program SpecialistDecember 31, 2014
Peterborough, NH


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