Definition of COPD

Chronic Obstructive Pulmonary Disease (COPD) is the term used to classify a collection of disorders including Chronic Bronchitis, Emphysema and Chronic Asthma, and is a leading cause of disability and health care usage in developed countries (Cooreman 1990).

The Impact of COPD

• COPD rates fourth as a cause of death and disability in the USA.
• The mortality rate for Australian males is close to 300 per 100,000 population, which is about 30% higher than in the US.
• Mortality comes after many years of morbidity. Breathlessness impacts on work, recreation, sleep and activities. It results in altered social and family status, with loss of self esteem, social mobility and independence for both the sufferer and the carer.
• Based on US statistics it is estimated that the annual direct and indirect costs for COPD in Australia is approximately $787 million.
• The Social Health Atlas 1992 showed that in New South Wales, Queensland, South Australia and Western Australia respiratory diseases rate third as causes of acute hospital admissions, and COPD accounts for 40% of these.
• Respiratory Disease ranks higher than heart disease, "back trouble", psychiatric disorders, infections, arthritis, and the common cold or influenza, as a reason for a doctors consultation.

COPD Characteristics and Impact on Quality of Life

COPD is characterised by chronic airflow obstruction and limitation and interferes with breathing, reduces energy and vitality, and produces progressive worsening and fluctuating symptoms which can be disabling for both the patients and their families.

Standard medical treatment is important in controlling some of the symptoms associated with the disease process. However, in some instances, the medical attitude towards COPD has been defeatist, aimed at only writing prescriptions and conditioned by the attitude that "there is nothing more than can be done" (Connors, pp12, 1993).

The individual with COPD often has several problems (physicial, psychological and social) and requires more than a prescription aimed at symptom relief (Rodregues, 1993). Many patients and their families are left alone to cope with the functional and emotional difficulties caused by this irreversible and progressive disease which can severely impair their quality of life.

Pulmonary Rehabilitation as a precursor to Patient Support Groups (PSG's) - the significance of psycho-social support

The past thirty years has seen the development of pulmonary rehabilitation in treating patients with COPD. The primary goal of pulmonary rehabilitation has been to restore the patient to the highest possible level of independent functioning (Connors, 1993).

Unfortunately there have been few randomised controlled trials in Australia which have assessed both the short and long term benefits of pulmonary rehabilitation.

Pulmonary rehabilitation has been conducted over the past 10 years at the Repatriation General Hospital in Adelaide, South Australia. A four year randomised controlled trial of this programme revealed that although rehabilitation significantly improved patients health status and quality of life, the effects began to dissipate 6 - 12 months after the intervention - with improvements returning to near baseline values by the end of 1 year.

The results also revealed the importance of psychosocial support in respiratory treatment. Patients who received the education component and psychosocial support from the hospital showed greater improvements in more aspects of health related quality of life than those that received education with no on-going support.

Based on these findings, it was concluded that more reinforcement and support, through ongoing care, was vital to sustain improvements and reduce health care usage in respiratory disease. One way in which this aim can be achieved is through the implementation of pulmonary Patient Support Groups (PSG's) following rehabilitation.

Patient Support Groups

Content updated, 2010