When Chronic Obstructive Pulmonary Disease (COPD) begets acute exacerbations, symptoms deteriorate, and patients experience breathlessness and overall reduced quality of life. A lot of resources go into ensuring that COPD patients receive the necessary care to lessen the exacerbations. There has been a paradigm from the traditional management of COPD with the development of new pharmacotherapies to mitigate the illness. Herein is a review of two articles that address the subject of COPD treatment protocols.
Prieto-Centurion, V., Markos, M. A., Ramey, N. I., Gussin, H. A., Nyenhuis, S. M., Joo, M. J.,… & Jaffe, H. A. (2014). Interventions to Reduce Re-hospitalizations after Chronic Obstructive Pulmonary Disease Exacerbations: A Systematic Review
The goal of the study by Prieto-Centurion et al. was to report on their findings of a systematic review carried out on Randomized Clinical Trials (RCTs) that evaluated interventions meant to reduce hospital readmission after COPD exacerbations. The researchers had two reasons to conduct the study. One reason is that data indicates that about one-fifth of patients hospitalized with COPD exacerbations in the US got readmitted in less than 30 days of getting discharged. Secondly, the Centers for Medicare and Medicaid Services had pondered revising the Hospital Readmissions Reduction Program to penalize financially healthcare facilities that elucidated a high all-cause 30-day readmission rate following a COPD exacerbation hospitalization from the first day of October 2014.
Prieto-Centurion and colleagues systematically searched different electronic databases to establish various and relevant research studied completed between January 1966 and mid-2013. The databases they rummaged for studies to review include, but not limited to, PubMed, EMBASE, CINAHL, and the Cochrane library. In their search, Prieto-Centurion and others involved a medical librarian in assisting in the search. They not only assessed the abstracts and titles of the studies but also evaluated the studies’ eligibility and credibility. The researchers also used predefined criteria to appraise every research that was potent for admission into their study. They examined a total of 913 titles and abstracts. Of these studies the researchers admitted five studies with a total of 1,393 participants because they met the admission criteria.
The primary variable that the researchers had an interest in was the re-hospitalization outcome. The five studies returned the primary result of readmission at either 6 or 12 months. There was no single study that assessed 30-day readmission as the primary indicator. All the studies evaluated different sets of interventions. Two studies, one Canadian and the other Spanish cum Belgian, indicated a drop in all-cause readmission over a year in the intervention group compared to the control group. The mean number of hospitalizations per patient amongst the intervention group was 1.0, while that of the control group was 1.8 (P= 0.01). The percent hospitalized in the intervention group was 45%, while the control group had 67% (P= 0.028). There was only one study from the US that reported a mortality risk that was more than two-fold higher in the intervention group (17% vs. 7%, P=0.003). However, there was no substantial variation in re-hospitalization between the control and the intervention groups. By and large, it was not clear which of the given interventions was effective or which was damaging.
Summarily, Prieto-Centurion, and colleagues could not find enough evidence from the studies that would have been ground substantial enough for them to recommend specific interventions to curb readmission amongst COPD patients from the RCTs. The researchers, borrowing from their findings, did not find a justification of financially penalizing healthcare facilities for elevated 30-day readmission rates following COPD exacerbations.
Prieto-Centurion et al.’s review did not differ much in findings from a similar and recent review, only that the latter was not about COPD. The two reviews reflected each other’s results; “that that no specific intervention or intervention bundle was consistently associated with a reduction in 30-day rehospitalization rates” (p.422). The study had a few limitations. For one, the researchers may have missed establishing other effective treatments because they restricted their study to RCTs without including evidence from different study designs. Nonetheless, RCTs are for many scholars, a source of quality, and robust evidence. The review also failed to include studies that specifically dwelt on pharmacological treatment alone. In this way, the researchers might have missed establishing pharmacological treatments effective in lowering readmissions. Availability of data was another potential limitation. From a personal perspective, however, the findings and inferences from the study are significantly satisfactory.
Restrepo, R. (2015). Year in Review 2014: COPD
In his study, Restrepo aimed at reviewing several but most significant results that pertained to the treatment and management of COPD with great emphasis on pharmacotherapy and disease management. Restrepo’s rationale for the review arises from the fact that despite the tremendous progress made in comprehending COPD’s pathophysiology, the management of COPD is still a menace and a challenge to clinicians. Moreover, there has been an explosion in research in all facets of COPD, and it was not any different in 2014.
Restrepo used the keyword COPD to search the PubMed database for 2014 alone, limiting his search to English studies and human trials. In total, the author had 691 references to review. Of all the manuscripts, the researcher evaluated only 150 of the 4,039 (4%) were clinical trials that specifically dwelt on the treatment and management of stable COPD. For this review, Restrepo majored on only 16 clinical trials and systematic reviews. The trials and reviews delved on two essential tenets in the treatment of COPD; that is the management of COPD and pharmacotherapy. The article particularly emphasizes on pulmonary rehabilitation, exercise training, and how anxiety and depression affect COPD management and pharmacotherapy. Restrepo also discussed specific agents and the role of medication and inhalation technique on the pharmacotherapy dimension.
In run down, Restrepo stresses that the management COPD and COPD patients has become more complicated. The reason for the elevated complexity is the vast number of medications available for administration. In 2014, a significant amount of studies like Mehring et al., Lou et al., and Pradella et al. affirmed the need for disease management programs and initiatives by proving the programs’ efficacy and effectiveness. By and large, COPD management programs lead to reduced mortality and depression and improved quality of life. Ricci et al. and Osterling et al. confirm the importance of exercise training in ameliorating health outcomes and quality of life for COPD patients. Together, smoking and depression raised mortality risks by up to 3.8 times, and together, smoking and anxiety disorders increased morality risks 4.3 times more.
Healthcare providers and policymakers should make every attempt to make sure that COPD patients get an adequate mental assessment as well as management of depression, stress, and anxiety; the linkage between COPD, depression, and anxiety makes there to be a very thin line separating death from life. In as far as pharmacology holds, inhaled agents (medications) are equally as good as the inhaler technique. A qualified and competent healthcare professional (in this case, a respiratory therapist (RT)) should exude competence and skill while using the commonest of inhalers. It is cost-effective to instruct patients on the most appropriate and right technique to use. It is also noteworthy to teach patients on the most recommendable technique because it betters their adherence to medication and dramatically alters clinical outcomes.
References
Prieto-Centurion, V., Markos, M. A., Ramey, N. I., Gussin, H. A., Nyenhuis, S. M., Joo, M. J.,… & Jaffe, H. A. (2014). Interventions to Reduce Re-Hospitalizations after Chronic Obstructive Pulmonary Disease Exacerbations. A Systematic Review. Annals of the American Thoracic Society, 11(3), 417-424. Web.
Restrepo, R. (2015). Year in Review 2014: COPD. Respiratory Care, 60(7), 1057-1060. Web.