title: Helping COPD patients change health behavior in order to improve their quality of life.
abstract: Chronic obstructive pulmonary disease (COPD) is one of the most prevalent and debilitating diseases in adults worldwide and is associated with a deleterious effect on the quality of life of affected patients. Although it remains one of the leading causes of global mortality, the prognosis seems to have improved in recent years. Even so, the number of patients with COPD and multiple comorbidities has risen, hindering their management and highlighting the need for futures changes in the model of care. Together with standard medical treatment and therapy adherence--essential to optimizing disease control--several nonpharmacological therapies have proven useful in the management of these patients, improving their health-related quality of life (HRQoL) regardless of lung function parameters. Among these are improved diagnosis and treatment of comorbidities, prevention of COPD exacerbations, and greater attention to physical disability related to hospitalization. Pulmonary rehabilitation reduces symptoms, optimizes functional status, improves activity and daily function, and restores the highest level of independent physical function in these patients, thereby improving HRQoL even more than pharmacological treatment. Greater physical activity is significantly correlated with improvement of dyspnea, HRQoL, and mobility, along with a decrease in the loss of lung function. Nutritional support in malnourished COPD patients improves exercise capacity, while smoking cessation slows disease progression and increases HRQoL. Other treatments such as psychological and behavioral therapies have proven useful in the treatment of depression and anxiety, both of which are frequent in these patients. More recently, telehealthcare has been associated with improved quality of life and a reduction in exacerbations in some patients. A more multidisciplinary approach and individualization of interventions will be essential in the near future.
authors.affiliation: Acute Geriatric Care Unit, Internal Medicine Department, University Hospital Mútua de Terrassa, Barcelona, Spain. 19908pam@comb.cat
authors.forename: Pere
authors.initials: P
authors.lastname: Almagro
authors.forename: Alejandra
authors.initials: A
authors.lastname: Castro
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D015897:Comorbidity; D003863:Depression / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D006233:Persons with Disabilities / Q000523:psychology / Q000534:rehabilitation; D005081:Exercise Therapy / Q000379:methods*; D015438:Health Behavior; D006801:Humans; D018529:Nutritional Support / Q000379:methods*; D010346:Patient Care Management; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications / Q000503:physiopathology / Q000523:psychology / Q000534:rehabilitation*; D011788:Quality of Life; D020127:Recovery of Function; D017216:Telemedicine; D016896:Treatment Outcome
keywords: COPD; comorbidity; disability; health related quality of life; pulmonary rehabilitation; telehealthcare
references.citation: Am J Respir Crit Care Med. 2013 Feb 15;187(4):347-65
references.pmid: 22878278
references.citation: Am J Respir Crit Care Med. 2013 Apr 1;187(7):668-71
references.pmid: 23540872
references.citation: Rev Clin Esp. 2012 Jun;212(6):281-6
references.pmid: 22521437
references.citation: Chest. 2002 May;121(5):1441-8
references.pmid: 12006426
references.citation: Respirology. 2013 May;18(4):616-29
references.pmid: 23432923
references.citation: PLoS One. 2013 Apr 05;8(4):e60532
references.pmid: 23585837
references.citation: Telemed J E Health. 2008 Mar;14(2):138-46
references.pmid: 18361703
references.citation: JAMA. 2011 Oct 26;306(16):1800-1
references.pmid: 22028358
references.citation: Am J Respir Crit Care Med. 2010 Oct 1;182(7):890-6
references.pmid: 20075385
references.citation: Am J Phys Med Rehabil. 2011 Feb;90(2):156-68
references.pmid: 20881587
references.citation: Cochrane Database Syst Rev. 2013 Jan 31;(1):CD000313
references.pmid: 23440778
references.citation: Am J Respir Crit Care Med. 2013 May 15;187(10):1035-6
references.pmid: 23675707
references.citation: Gen Hosp Psychiatry. 2011 May-Jun;33(3):217-23
references.pmid: 21601717
references.citation: Am J Med. 2009 Aug;122(8):778.e9-15
references.pmid: 19635280
references.citation: Int J Chron Obstruct Pulmon Dis. 2012;7:653-61
references.pmid: 23055714
references.citation: Cochrane Database Syst Rev. 2012 Apr 18;(4):CD006560
references.pmid: 22513941
references.citation: Patient Educ Couns. 2011 Apr;83(1):29-36
references.pmid: 20447795
references.citation: COPD. 2012 Aug;9(4):390-4
references.pmid: 22497561
references.citation: Lancet. 2012 Jul 7;380(9836):37-43
references.pmid: 22579043
references.citation: COPD. 2012 Aug;9(5):492-8
references.pmid: 22958111
references.citation: Eur Respir J. 2010 Nov;36(5):1042-8
references.pmid: 20413540
references.citation: Ann Intern Med. 2012 May 15;156(10):673-83
references.pmid: 22586006
references.citation: QJM. 2011 Oct;104(10):859-66
references.pmid: 21622541
references.citation: Eur Respir J. 2006 Jul;28(1):123-30
references.pmid: 16611656
references.citation: JAMA. 2012 Jun 20;307(23):2493-4
references.pmid: 22797447
references.citation: Arch Phys Med Rehabil. 2003 Aug;84(8):1154-7
references.pmid: 12917854
references.citation: Thorax. 2009 Nov;64(11):939-43
references.pmid: 19703830
references.citation: Curr Med Res Opin. 2011 May;27(5):981-6
references.pmid: 21385019
references.citation: Lancet. 2012 Dec 15;380(9859):2163-96
references.pmid: 23245607
references.citation: Res Dev Disabil. 1995 Jan-Feb;16(1):51-74
references.pmid: 7701092
references.citation: Lancet. 2012 Dec 15;380(9859):2095-128
references.pmid: 23245604
references.citation: BMJ. 2012 Mar 06;344:e1060
references.pmid: 22395923
references.citation: J Am Geriatr Soc. 2012 Oct;60(10):E1-E25
references.pmid: 22994865
references.citation: Int J Chron Obstruct Pulmon Dis. 2009;4:337-49
references.pmid: 19802349
references.citation: Am J Respir Crit Care Med. 2013 Apr 1;187(7):728-35
references.pmid: 23392440
references.citation: Thorax. 2009 Apr;64(4):326-31
references.pmid: 19074931
references.citation: Respir Med. 2013 Feb;107(2):242-8
references.pmid: 23085213
references.citation: Int J Chron Obstruct Pulmon Dis. 2012;7:297-320
references.pmid: 22665994
references.citation: N Engl J Med. 2013 Jan 10;368(2):100-2
references.pmid: 23301730
references.citation: JAMA. 2005 Aug 10;294(6):716-24
references.pmid: 16091574
references.citation: Clin Sci (Lond). 2010 Feb 09;118(9):565-72
references.pmid: 20132099
references.citation: Chest. 2013 May;143(5):1444-1454
references.pmid: 23648908
references.citation: J Cardiopulm Rehabil Prev. 2013 Mar-Apr;33(2):113-23
references.pmid: 23434613
references.citation: Am Rev Respir Dis. 1988 May;137(5):1075-82
references.pmid: 3057956
references.citation: Med Sci Sports Exerc. 2012 Jul;44(7):1212-8
references.pmid: 22293866
references.citation: BMJ. 2011 Feb 03;342:d120
references.pmid: 21292710
references.citation: BMJ. 2011 Jan 24;342:d142
references.pmid: 21262897
references.citation: Eur Respir J. 2008 Mar;31(3):667-77
references.pmid: 18310400
references.citation: J Telemed Telecare. 2010;16(3):120-7
references.pmid: 20197355
references.citation: Chest. 2013 Oct;144(4):1163-1178
references.pmid: 23722528
references.citation: Am J Respir Crit Care Med. 2007 Mar 1;175(5):458-63
references.pmid: 17158282
references.citation: Intern Emerg Med. 2014 Jun;9(4):419-25
references.pmid: 23645508
references.citation: J Clin Epidemiol. 2003 Dec;56(12):1177-84
references.pmid: 14680668
references.citation: Am J Respir Crit Care Med. 2004 Oct 1;170(7):748-52
references.pmid: 15256394
references.citation: Chest. 2000 Apr;117(4):976-83
references.pmid: 10767227
references.citation: Thorax. 2011 Feb;66(2):108-14
references.pmid: 21047868
references.citation: Age Ageing. 2006 Jan;35(1):33-7
references.pmid: 16364931
references.citation: Health Qual Life Outcomes. 2007 Aug 06;5:52
references.pmid: 17683600
references.citation: Health Qual Life Outcomes. 2004 Sep 20;2:51
references.pmid: 15380021
references.citation: Am J Clin Nutr. 2000 Dec;72(6):1415-6
references.pmid: 11101463
references.citation: Respir Med. 2009 Jul;103(7):963-74
references.pmid: 19285850
references.citation: Thorax. 2008 Sep;63(9):831-8
references.pmid: 18728206
references.citation: BMJ. 2010 Apr 20;340:c1718
references.pmid: 20406866
references.citation: Am J Phys Med Rehabil. 2007 Jan;86(1):30-6
references.pmid: 17304686
references.citation: Cochrane Database Syst Rev. 2011 Jul 06;(7):CD007718
references.pmid: 21735417
references.citation: Eur Respir J. 2010 Mar;35(3):557-63
references.pmid: 19741029
references.citation: BMJ. 2013 Feb 26;346:f653
references.pmid: 23444424
references.citation: Arch Intern Med. 2003 Mar 10;163(5):585-91
references.pmid: 12622605
references.citation: JAMA. 2011 Oct 26;306(16):1782-93
references.pmid: 22028354
references.citation: Lancet. 2000 Jan 29;355(9201):362-8
references.pmid: 10665556
references.citation: Thorax. 2010 Apr;65(4):298-302
references.pmid: 20388752
references.citation: Cochrane Database Syst Rev. 2012 Dec 12;12:CD000998
references.pmid: 23235577
references.citation: BMC Pulm Med. 2011 Feb 25;11:13
references.pmid: 21352544
references.citation: Respir Med. 2013 Feb;107(2):233-41
references.pmid: 23098687
references.citation: Cochrane Database Syst Rev. 2007 Oct 17;(4):CD002990
references.pmid: 17943778
references.citation: Respirology. 2012 May;17(4):627-38
references.pmid: 22309179
references.citation: Qual Life Res. 2013 May;22(4):791-9
references.pmid: 22684529
references.citation: Cochrane Database Syst Rev. 2011 Oct 05;(10):CD005305
references.pmid: 21975749
references.citation: Prim Care Respir J. 2011 Sep;20(3):257-68
references.pmid: 21472192
references.citation: Cochrane Database Syst Rev. 2012 May 16;(5):CD003573
references.pmid: 22592692
references.citation: Thorax. 2011 Jan;66(1):26-31
references.pmid: 21037270
references.citation: BMJ. 2012 Sep 03;345:e5205
references.pmid: 22945950
references.citation: Ont Health Technol Assess Ser. 2012;12(10):1-65
references.pmid: 23074420
references.citation: Psychol Med. 2001 May;31(4):717-23
references.pmid: 11352373
references.citation: Am J Respir Crit Care Med. 2006 Jun 15;173(12):1390-413
references.pmid: 16760357
references.citation: Chron Respir Dis. 2011;8(2):89-99
references.pmid: 21596892
references.citation: J Rehabil Med. 2012 May;44(5):466-72
references.pmid: 22549658
references.citation: Expert Rev Respir Med. 2012 Jun;6(3):239-42
references.pmid: 22788935
references.citation: Chest. 2012 Nov;142(5):1126-1133
references.pmid: 23303399
references.citation: BMC Med Res Methodol. 2012 Feb 21;12:17
references.pmid: 22353210
references.citation: Int J Chron Obstruct Pulmon Dis. 2012;7:743-55
references.pmid: 23152679
references.citation: Eur J Intern Med. 2012 Jul;23(5):442-6
references.pmid: 22726373
references.citation: Thorax. 2003 Sep;58(9):752-6
references.pmid: 12947130
references.citation: Thorax. 2010 Aug;65(8):711-8
references.pmid: 20685746
references.citation: Eur Respir J. 2009 Sep;34(3):648-54
references.pmid: 19720809
references.citation: PLoS One. 2012;7(10):e46433
references.pmid: 23110052
references.citation: Br J Health Psychol. 2008 Sep;13(Pt 3):381-400
references.pmid: 17535503
references.citation: Eur Respir J. 2013 Apr;41(4):815-23
references.pmid: 22878874
references.citation: Int J Tuberc Lung Dis. 2013 Jan;17(1):131-6
references.pmid: 23114257
references.citation: Patient Educ Couns. 1996 Nov;29(2):167-78
references.pmid: 9006233
references.citation: Cochrane Database Syst Rev. 2008 Oct 08;(4):CD002295
references.pmid: 18843632
references.citation: Chest. 2013 Sep;144(3):766-777
references.pmid: 23429910
references.citation: Pulm Med. 2012;2012:868294
references.pmid: 22988502
references.citation: Lancet. 2012 Jul 7;380(9836):7-9
references.pmid: 22579042
references.citation: Clin Respir J. 2010 Oct;4(4):208-14
references.pmid: 20887343
references.citation: Cochrane Database Syst Rev. 2006 Oct 18;(4):CD003793
references.pmid: 17054186
references.citation: Arch Intern Med. 2009 Apr 13;169(7):694-701
references.pmid: 19364999
references.citation: Fam Pract. 2007 Oct;24(5):412-9
references.pmid: 17698977
references.citation: Chest. 1995 May;107(5 Suppl):187S-193S
references.pmid: 7743825