Chronic obstructive pulmonary disease patient care in family medicine

Kronična opstruktivna plućna bolest (KOPB) je multisustavna upalna bolest dišnih putova i plućnog parenhima karakterizirana najčešće progresivnom opstrukcijom dišnih putova koja nije u potpunosti reverzibilna, a uzrokovana je neprimjerenim upalnim odgovorom dišnih putova i plućnog parenhima na dugotrajnu izloženost štetnim tvarima i plinovima, najčešće pušenju. Sukladno smjernicama za postavljanje dijagnoze, liječenja i prevencije KOPB-a, koje izdaje Globalna inicijativa za kroničnu opstruktivnu plućnu bolest (engl. GOLD), na KOPB je potrebno posumnjati u svakog bolesnika s dispnejom, kroničnim kašljem i iskašljajem koji ima anamnezu izloženosti čimbenicima rizika. Za postavljanje dijagnoze potrebna je spirometrija, a u slučaju nedostupnosti spirometrije ili nemogućnosti njezine pravilne interpretacije, preporuka je bolesnika uputiti u specijalizirane ustanove. Unatoč preporuci odabira terapije utemeljene na dokazima u cilju poboljšanja ishoda bolesti i općeg stanja bolesnika te smanjenja nepotrebnog ekonomskog troška, istraživanja upućuju da dio liječnika obiteljske medicine ne propisuje lijekove prema GOLD smjernicama. Jedna od poteškoća u skrbi za bolesnike s KOPB-om je i njihova nedovoljna suradljivost u pravilnom uzimanju propisanih lijekova. Stoga bi, u cilju povećanja suradljivosti bolesnika, trebalo na njima razumljiv način objasniti način uzimanja lijekova uz naglasak na redovitom i pravilnom uzimanju lijeka. Akutne egzacerbacije KOPB-a kao i mogući ekstrapulmonalni simptomi značajno pridonose opterećenju bolesti i smanjenju kvalitete života te ih je bitno pravodobno prepoznati i prikladno liječiti. KOPB visokom prevalencijom i mortalitetom, smanjenjem kvalitete života bolesnika te opterećenjem zdravstvenog sustava predstavlja važan javnozdravstveni problem. Stoga je potreba da liječnici obiteljske medicine pravovremenim postavljanjem dijagnoze otkriju bolesnika s KOPB-om u ranoj fazi bolesti, propišu adekvatno liječenje, prate tijek bolesti i njegovanjem partnerskog odnosa s bolesnikom potiču suradljivost bolesnika aktivnim uključivanjem u njegovu edukaciju i liječenje.Chronic Obstructive Pulmonary Disease is a multisystemic, inflammatory disease of the lung parenchyma and airways usually characterized by progressive, irreversible obstruction of airways due to modified inflammatory response to long-term inhalation of noxious particles, most frequently cigarette smoking. According to the guidelines for the diagnosis, treatment and prevention of COPD developed by the Global Initiative for Chronic Obstructive Lung Disease (GOLD), COPD diagnosis should be considered in any patient who has dyspnea, chronic cough or sputum production, and a history of exposure to risk factors. Spirometry is required to make the diagnosis, and if spirometry is unavailable or cannot be accurately interpreted, it is recommended to refer the patient to a specialist. Despite the recommendations for evidence-based prescription of COPD treatments with intention of improvement of disease outcomes, patients’ quality of life and reduction of unnecessary economic costs, studies have shown that a significant number of family physicians do not prescribe treatment according to GOLD guidelines. One of the difficulties in COPD patient care is inadequate adherence to prescribed therapies. Therefore, with the goal of increasing patient compliance, family physicians should explain the way of administering the medicine in a way the patient could understand while emphasizing the importance of regular and correct usage of the prescribed medicine. Acute exacerbations of COPD, as well as possible extrapulmonary symptoms, can significantly contribute to the burden of the disease and reduction of quality of life and therefore should be duly recognized and appropriately managed. COPD, with its high prevalence and mortality, reduction of patient quality of life and economic burden, is an important health care problem. Consequently, family physicians should aspire to recognize and diagnose patients with COPD while the disease is in its early stages, to prescribe adequate treatment, and to cultivate a partnership with the patient by actively participating in their education and treatment