Shawn D Aaron draws attention to the fact that patients with COPD are prone to acute respiratory exacerbations, with a possible detrimental effect on patients’ health status, in a state of the art review. Initial treatment is unsuccessful in about a quarter off all patients. The author addresses the benefits and many limitations of established COPD therapies.
His final outlook is that new potential drugs—including mitogen activated protein kinase inhibitors, phosphodiesterase 3 inhibitors, and monoclonal antibodies to the interleukin 1 receptor—offer additional hope for treatments that may prevent exacerbations in the future.
Annemarije L Kruis and colleagues published a cluster randomised trial on the effectiveness of integrated disease management for primary care chronic obstructive pulmonary disease patients. They compared health status at 12 months and quality of life in the intervention group—practices with specially trained general practitioners, practice nurses, and specialised physiotherapists—to treatment as usual. They report that this integrated disease management approach delivered in primary care showed no additional benefit.
In a related editorial, Jean Bourbeau acknowledges that these results are disappointing. What we still need to learn is how best to deliver healthcare that is better integrated and more coherent. He advocates a strategic alliance between primary and secondary care, supported by interdisciplinary teams, for patients with high risk COPD.
Georg Roeggla is an associate editor for The BMJ.