Why do patients with severe chronic obstructive pulmonary disease (COPD) need 6-monthly check-ups at their general practitioner?

1
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_at_health.sdu.dk.

2
430,000 persons in Denmark have COPD
9.5 of the adult population
Løkke A, 2007
25,000 have severe COPD

• at least 1 hospitalization

• FEV1 35 on average

• 10 patients per GP

3
Recommendations
6-monthly check-ups ?
COPD patient Male Female Visits daytime
8 8 Telephone 9 12 Visits
after hours 2 3 Contacts per year
19 23 Bilde L, 2003

• Rehabilitation
• Exercise
• Self management
• Smoking cessation
• Dietary advice

Vaccinations
6-monthly check-ups
3
4
1 year mortality 35
Eriksen N, 2003
- 40 COPD
- 30 cardiovascular disease
- 8 pulmonary cancer
- 22 other causes
Chatila W M, 2008
4
5
10 mortality during admission
Eriksen N, 2003
5
6
Cause of death based on autopsy
37 cardiac failure
28 pneumonia
21 pulmonary embolism
14 COPD
58 chronic heart failure
Zvezdin B, 2009
7
Screening the patients
60 ECG signs of Right ventricular overload
..all diagnoses other than pregnancy-related
diseases Bilde L, 2007
21 ECG signs of IHD
Antonelli et al, 1997
25 Pulmonary embolism
Tillie-Leblond I, 2006
45 Major depression
Ng T P et al, 2007
68 Osteoporosis
Jørgensen N R, 2007
8

Why comorbidity?
COPD predicts

• Depression
• Cardiovascular disease
• Pulmonary cancer
• Osteoporosis

• Smoking
• Age
• Corticosteroids

Van den Bemt L et al, 2009
Inflammation
Truelsen T et al, 2001
Barnes PJ et al, 2009

• Hypoxia
• Immobilisation

Mannino DM et al, 2003
Jørgensen NR et al, 2006
9
Why do patients with severe COPD need 6 monthly
check-ups at their general practitioner?
10
Bad prognosis
Critical - Hidden - Treatable Comorbidities
Depression
Cardiovascular
Cancer
Osteoporosis
11
Thank you for your attention