title: Four patients with a history of acute exacerbations of COPD: implementing the CHEST/Canadian Thoracic Society guidelines for preventing exacerbations.
abstract: The American College of Chest Physicians and Canadian Thoracic Society have jointly produced evidence-based guidelines for the prevention of exacerbations in chronic obstructive pulmonary disease (COPD). This educational article gives four perspectives on how these guidelines apply to the practical management of people with COPD. A current smoker with frequent exacerbations will benefit from support to quit, and from optimisation of his inhaled treatment. For a man with very severe COPD and multiple co-morbidities living in a remote community, tele-health care may enable provision of multidisciplinary care. A woman who is admitted for the third time in a year needs a structured assessment of her care with a view to stepping up pharmacological and non-pharmacological treatment as required. The overlap between asthma and COPD challenges both diagnostic and management strategies for a lady smoker with a history of asthma since childhood. Common threads in all these cases are the importance of advising on smoking cessation, offering (and encouraging people to attend) pulmonary rehabilitation, and the importance of self-management, including an action plan supported by multidisciplinary teams.
authors.affiliation: 1] Agia Barbara Health Care Center, Heraklion, Crete, Greece [2] Department of Thoracic Medicine, Clinic of Social and Family Medicine, University of Crete, Heraklion, Crete, Greece.
authors.forename: Ioanna
authors.initials: I
authors.lastname: Tsiligianni
authors.affiliation: Department of Medicine, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada.
authors.forename: Donna
authors.initials: D
authors.lastname: Goodridge
authors.affiliation: Division of Respirology, Critical Care and Sleep Medicine, University of Saskatchewan, Saskatoon, SK, Canada.
authors.forename: Darcy
authors.initials: D
authors.lastname: Marciniuk
authors.affiliation: Centre for Primary Care and Public Health, Blizard Institute, Queen Mary University of London, London, UK.
authors.forename: Sally
authors.initials: S
authors.lastname: Hull
authors.affiliation: Respiratory Epidemiology and Clinical Research Unit, Montreal Chest Institute, McGill University Health Centre, Montréal, QC, Canada.
authors.forename: Jean
authors.initials: J
authors.lastname: Bourbeau
mesh_terms: D000305:Adrenal Cortex Hormones / Q000008:administration & dosage; D000368:Aged; D001249:Asthma / Q000453:epidemiology; D002170:Canada; D019468:Disease Management; D018450:Disease Progression; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D029424:Pulmonary Disease, Chronic Obstructive / Q000517:prevention & control* / Q000534:rehabilitation; D012648:Self Care; D012907:Smoking / Q000453:epidemiology; D016540:Smoking Cessation; D012955:Societies, Medical
chemical_list: D000305:Adrenal Cortex Hormones