Diapositiva 1

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First World Conference of COPD Patients The COPD
Patient at the Crossroads 14 giugno 2009 - Roma
Implementation of Effective COPD Management
Programs
Prof. Lorenzo Corbetta Firenze lorenzo.corbetta_at_un
ifi.it
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PROGETTO MONDIALE BPCOStruttura

• GOLD Executive Committee
• Roberto Rodriguez-Roisin, MD Chair
• Klaus Rabe, MD, PhD Co-Chair

Science Committee Klaus Rabe, MD, PhD - Chair
Dissemination/Implementation Task Group
Christine Jenkins, MD - Chair
GOLD National Leaders - GNL
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RATIONALE

• Evidence is increasing that a chronic disease
  management program for COPD patients that
  incorporates a variety of interventions, includes
  pulmonary rehabilitation, and is implemented by
  primary care reduce hospital admissions and bed
  days.
• Key elements are patient participation and
  information sharing among health care providers

Rea H, McAuley S, Stewart A, Lamont C, Roseman P,
Didsbury P. A chronic disease management
programme can reduce days in hospital for
patients with chronic obstructive pulmonary
disease. Intern Med J 200434(11)608-14.
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MODELS OF LOCAL IMPLEMENTATION OF GOLD
GUIDELINES THE ITALIAN EXPERIENCE THE 10 KEY
POINTS

• Annual scientific meeting in order to discuss the
  International Guidelines every March as of 2002
• Set up a joint project with the Italian Leaders
  of the main International guidelines regarding
  the field of Pneumology GOLD, GINA, ARIA which
  is called LIBRA (Linee Guida Italiane BPCO,
  Rinite, Asma)
• Close relationships with the Lung Societies, GPs
  Associations, Patients organizations
• Organization of the WCD with the Italian
  Association of COPD Patients
• Translation of all materials which can be freely
  accessed by specialists and GPs for educational
  purposes.
• Website www.goldcopd.it and multimedial
  materials as well as the more traditional ones.
• CME courses on COPD using the official GOLD and
  LIBRA materials
• Program of Fund raising
• Media to raise awareness of COPD
• Official acceptance of LIBRA as a GARD
  participant.

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MODELS OF LOCAL IMPLEMENTATION OF GOLD
GUIDELINES THE ITALIAN EXPERIENCE THE 10 KEY
POINTS

• Annual scientific meeting in order to discuss the
  International Guidelines every march as of 2002
• Set up a joint project with the Italian Leaders
  of the main International guidelines regarding
  the field of Pneumology GOLD, GINA, ARIA which
  is called LIBRA (Linee Guida Italiane BPCO,
  Rinite, Asma)
• Close relationships with the Lung Societies, GPs
  Associations, Patients organizations
• Organization of the WCD with the Italian
  Association of COPD Patients
• Translation of all materials which can be freely
  accessed by specialists and GPs for educational
  purposes.

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ANNUAL SCIENTIFIC MEETING

• It consists of 3 main parts
• General discussion of the International
  guidelines in 3 different Working Groups (GOLD,
  GINA, ARIA) with the aim of adapting the
  international guidelines to make them suitable in
  the national context.
• Presentations given by the national and
  international outstanding experts in COPD who
  have been invited to present the data which has
  led to the new recommendations with subsequent
  question and answer session.
• Presentation of the first draft of the Italian
  guidelines involving all Workshop participants

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Chairman Susan Hurd
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PROGETTO MONDIALE BPCO
lobal Initiative for Chronicbstructiveungisease
GOLD
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MODELS OF LOCAL IMPLEMENTATION OF GOLD
GUIDELINES THE ITALIAN EXPERIENCE THE 10 KEY
POINTS

• Annual scientific meeting in order to discuss the
  International Guidelines every march as of 2002
• Set up a joint project with the Italian Leaders
  of the main International guidelines regarding
  the field of Pneumology GOLD, GINA, ARIA which
  is called LIBRA (Linee Guida Italiane BPCO,
  Rinite, Asma)
• Close relationships with the Lung Societies, GPs
  Associations, Patients organizations
• Organization of the WCD with the Italian
  Association of COPD Patients
• Translation of all materials which can be freely
  accessed by specialists and GPs for educational
  purposes.

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www.progettolibra.it
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MODELS OF LOCAL IMPLEMENTATION OF GOLD
GUIDELINES THE ITALIAN EXPERIENCE THE 10 KEY
POINTS

• Annual scientific meeting in order to discuss the
  International Guidelines every march as of 2002
• Set up a joint project with the Italian Leaders
  of the main International guidelines regarding
  the field of Pneumology GOLD, GINA, ARIA which
  is called LIBRA (Linee Guida Italiane BPCO,
  Rinite, Asma)
• Close relationships with the Lung Societies, GPs
  Associations, Patients organizations
• Organization of the WCD with the Italian
  Association of COPD Patients
• Translation of all materials which can be freely
  accessed by specialists and GPs for educational
  purposes.

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MODELS OF LOCAL IMPLEMENTATION OF GOLD
GUIDELINES THE ITALIAN EXPERIENCE THE 10 KEY
POINTS

• Annual scientific meeting in order to discuss the
  International Guidelines every march as of 2002
• Set up a joint project with the Italian Leaders
  of the main International guidelines regarding
  the field of Pneumology GOLD, GINA, ARIA which
  is called LIBRA (Linee Guida Italiane BPCO,
  Rinite, Asma)
• Close relationships with the Lung Societies, GPs
  Associations, Patients organizations
• Organization of the WCD with the Italian
  Association of COPD Patients
• Translation of all materials which can be freely
  accessed by specialists and GPs for educational
  purposes.

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World Asthma Day organized by LIBRA
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MODELS OF LOCAL IMPLEMENTATION OF GOLD
GUIDELINES THE ITALIAN EXPERIENCE THE 10 KEY
POINTS

• Annual scientific meeting in order to discuss the
  International Guidelines every march as of 2002
• Set up a joint project with the Italian Leaders
  of the main International guidelines regarding
  the field of Pneumology GOLD, GINA, ARIA which
  is called LIBRA (Linee Guida Italiane BPCO,
  Rinite, Asma)
• Close relationships with the Lung Societies, GPs
  Associations, Patients organizations
• Organization of the WCD with the Italian
  Association of COPD Patients
• Translation of all materials which can be freely
  accessed by specialists and GPs for educational
  purposes.

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Workshop Report 2008
Executive Summary 2008
Patient Guide
Pocket Guide 2008
Educational Slide-kit
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Newsletter speciali Progetto Libra
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INITIATIVES FOR COPD PATIENTSCOPD PATIENT DIARY

• Its a booklet for COPD patients which
• Describes the condition and how to live with it
• Makes it possible to record patient details such
  as symptoms, respiratory function, exacerbations
  and treatment with the aim of
• Making the patient more aware of his/her
  condition
• Making it possible to monitor the progression of
  the illness
• Improving communication between the GP and the
  specialist

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COPD PATIENT DIARY
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www.admitonline.info
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COPD FlashInhalation treatment to reach therapy
objectives

• Scenario a 56 year old patient with COPD
  experiences coughing and dyspnea when he goes up
  the stairs or when carrying the shopping. He
  frequently uses bronchodilators as relievers as
  much as ten times a day and cough syrup. He
  frequently has a worsening of coughing with
  phlegm and dyspnea. Due to his ill health he
  often has to take time off work and risks losing
  his job for this reason. The scene shows the man
  out of puff and with a grey complexion climbing
  the stairs and when he gets to the top of the
  stairs he incorrectly uses his bronchodilator and
  resigns himself to the fact that he will never
  get better. Worried that his medication is
  finished he makes an appointment with his family
  doctor to have a repeat prescription.
• Scene 2 the patient enters the doctors surgery
  and complains to his doctor that his medication
  isnt working.
• If you were the doctor what would you do?
• a. repeat the usual prescription
• b. ask if patient is exposed to risk factors
• c. admit the patient to hospital
• Educational message the most important thing is
  to further investigate to find out if the patient
  is smoking or exposed to other risk factors. The
  elimination of risk factors is the key to
  improving patient health
• Scene 3 Patient stopped smoking 5 years before.
  If you were the doctor what would you do?
• Repeat the usual prescription
• Establish the severity of the disease
• Admit the patient to the hospital
• Educational message in a COPD patient the
  treatment prescribed must be based on the
  severity of the disease. Show the classification
  of COPD based on spirometry and ABG

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COPD FlashInhalation treatment to reach therapy
objectives

• Scene 4 doctor performs and/or requests a
  spirometry and a ABG analisys to be compared with
  previous results and concludes that there is no
  variation. If you were the doctor what would you
  do?
• a. Check compliance and inhalation technique
• b. Repeat the usual prescription
• c. Admit the patient to hospital
• Educational message the key to obtaining good
  results with pharmacologic therapy in patients
  with COPD is to take therapy regularly over a
  long period of time. In fact the most important
  trials have shown an improvement of symptoms and
  exercise tolerance, reduction of exacerbation,
  improved quality of life over a period of several
  years of treatment. Constant monitoring of
  inhalation technique is an essential part of
  pharmacotherapy
• Scene 5 What should you do if your patient is
  unable to use the prescribed treatment correctly?
• a. Prescribe only medication which is to be
  taken orally
• b Prescribe a more appropriate device based
  mainly on coordination and maximum inhalation
  flow
• c. Prescribe only a nebulizer
• Educational message doctors have to choose the
  right device to suit each individual patient.
  (Show the flow-chart for making the right choice)
• Scene 6 If the patient continues to complain
  about his symptoms
• Check for comorbidities
• Prescribe oral corticosteroids
• Admit patient to hospital
• Educational message patients who are elderly
  and smokers or ex smokers often suffer from
  comorbidities such as chronic cardiac failure,
  hypertension, diabetes, osteoporosys, metabolic
  syndrome etc that complicate their condition
• Scene 7 And what is the final recommendation?
• a. Maintain a regular diet and exercise routine

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Decisional Support within the Electronic
Clinical Record for GPs
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First World Conference of COPD Patients The COPD
Patient at the Crossroads 14 giugno 2009 - Roma
Implementation of Effective COPD Management
Programs
Prof. Lorenzo Corbetta Firenze lorenzo.corbetta_at_un
ifi.it
Thank you for joining us here in Rome!