Chronic Obstructive Pulmonary Disease in Long-Term Care

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Author(s): 

Roy A. Pleasants, PharmD

author affiliations:

Dr. Pleasants is Associate Professor, Campbell University School of Pharmacy, Buies Creek, NC, and Assistant Professor, Division of Pulmonary and Critical Care Medicine, Duke University School of Medicine, Durham, NC.

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Chronic obstructive pulmonary disease (COPD) is a disease with a progressive and complex nature, and therefore is commonly found in nursing home residents. COPD has been found to be as likely as kidney disease to lead to admission to a skilled nursing facility in elderly patients who underwent coronary artery bypass surgery. Whereas death from heart disease and stroke are declining, the death rate from COPD is on the increase. According to one study, one in every six admissions to nursing homes was for patients with a history of emphysema or COPD. Tobacco smoking is the primary cause of COPD in 80-90% of persons who have the disease. This article discusses relevant issues for persons with COPD residing in LTC facilities. (Annals of Long-Term Care: Clinical Care and Aging 2009;17[3]:24-30)

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Introduction

Chronic obstructive pulmonary disease (COPD) occurs in about 5% to 6% of the U.S. adult population. The typical patient with COPD is an elderly person who smoked cigarettes for years, has multiple comorbidities, and is significantly limited by his or her disease(s). Tobacco smoking is the primary cause of COPD in 80-90% of persons who have the disease1 and is characterized by a progressive decline in lung function and functional impairment. COPD has a significant impact on society; the death rate from COPD is increasing, whereas death due to heart disease and stroke are declining. Because of the progressive and complex nature of COPD, it is a common disease encountered in the nursing home resident. This review article will discuss relevant issues for persons with COPD residing in long-term care (LTC) facilities.

COPD in the Nursing Home

A significant number of individuals with COPD are admitted to LTC facilities at some point in their disease. According to one study, about one of every six admissions to nursing homes was for patients with a history of emphysema or COPD.2 In the last 12 months of COPD patients’ lives, one recent study reported there was a 40% likelihood of being admitted to a LTC facility.3 The presence of COPD was as likely as kidney disease to lead to admission to a skilled nursing facility (SNF) in elderly patients who underwent coronary artery bypass surgery.4 In 2004, 10% of patients with COPD enrolled in California Medicare were admitted to a SNF.5 In a Medicaid COPD population, approximately 22% of the respiratory-related healthcare costs are nursing home costs; a greater amount was spent on hospitalizations (approximately 50%).6

COPD Guidelines

The Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines, an international effort, became available in 2001 and has been updated annually (www.goldcopd.org).7 The American Thoracic Society (ATS) and European Respiratory Society (ERS) also developed joint guidelines in 2004, similar to GOLD in many regards, but they provide additional information on some topics (www.thoracic.org). There likely will be increased quality assurance healthcare initiatives involving patients with COPD based on these guidelines.

Definition/Prognosis

Chronic obstructive pulmonary disease is defined as a disease characterized by airflow limitation (obstruction) that is not fully reversible. The airflow limitation is progressive and is associated with an abnormal inflammatory response of the lungs to noxious particles or gases (eg, tobacco smoke). The ATS defines chronic bronchitis as a chronic productive cough for 3 months in each of 2 consecutive years in a patient in whom other causes of chronic cough have been excluded.

References: 


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