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Local COPD guideline ensures equitable treatment

 The main cause of COPD is tobacco smoking but there are environmental factors like air pollution and biomass fuel, genetic abnormalities, abnormal development and aging, among others

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SHORTNESS of breath during activities, cough and phlegm are the symptoms of COPD. / PHOTOGRAPH COURTESY OF sheffield.ac.uk

The Philippine College of Chest Physicians (PCCP) and its partner-institutions have completed the local guideline for the management and treatment of chronic obstructive pulmonary disease (COPD), taking into consideration Covid-19 and ways to minimize out-of-pocket expenses of patients.

On Tuesday, 16 November, members of the PCCP Council on COPD and Pulmonary Rehabilitation, represented by Dr. Lenora Fernandez, Dr. Tim Trinidad, Dr. Bernice Ong-Dela Cruz and Dr. Steffani Paraguas, presented the local adaptation of the COPD guideline with emphasis on protocols at the primary care level to make it consistent with universal health care.

According to Dr. Fernandez, one of the proponents of the consensus guideline, the main reason is to implement equity in treating COPD.

“There’s a discrepancy in the cost of evidence-based medicines for COPD versus what the average Filipino can afford. This is why we saw the need to translate this in the local scenario because of our out-of-pocket medical system,” the head of the Pulmonary Medicine Division of the Philippine General Hospital noted in a separate interview.

The experts emphasize the importance of public awareness and openness to seeking medical intervention if they have the condition. They want the public to be aware of the ill effects of COPD for early detection and primary care as it could cause irreversible damage to one’s health.

The group came up with the Philippine COPD Management Algorithm Guideline which is a summary of consensus recommendations between PCCP and partner stakeholders including the primary care practitioners, the Philippine College of Physicians (PCP) and the Philippine Academy of Family Physicians (PAFP) on the care and management of COPD designed for the Philippine setting.

Specifically, Dr. Fernandez stressed that “the main objective is to provide a simple guide to all healthcare workers who manage possible COPD patients within the Universal healthcare framework of our country and the presence of Covid-19 infection” giving utmost consideration to the vulnerable population who faces the highest risk.

What is COPD?
COPD is a condition in which there is a narrowing of the airways due to swelling or inflammation and excessive mucus production, while the air sacs are damaged. This causes airflow blockage and problems in breathing.

The main cause of COPD is tobacco smoking but there are environmental factors like air pollution and biomass fuel, genetic abnormalities, abnormal development and aging considered also as among the main causes. Its symptoms include shortness of breath during activities, cough and phlegm.

It is one of the top 10 diseases in the Philippines and third-leading cause of mortality globally.

Key points
In the guideline, primary care physicians are guided on how to identify the signs and symptoms and use the information to arrive at a diagnosis of probable COPD or identify those who are in exacerbation.

Parameters to monitor the condition of the patient with COPD are also set for continuity of care. It defines when the patient will be returned to his or her family with the family and community medicine specialist continuing the care of the patients.

On the part of the public, the experts encourage patients with high symptom burden of COPD to avail of pulmonary rehabilitation programs to prevent progression.

Dr. Paraguas said there are currently 11 hospitals and centers across the country that offer pulmonary rehabilitation programs.

She explained that out-patient programs commonly run for about two to three days a week with each session lasting for about one to four hours and offer structured and monitored exercise training that improves muscle function to decrease shortness of breath; education on maintaining and improving body function; nutritional advice; emotional and psychological support; and instructions on breathing techniques.

Specifically, community medicine specialists may provide health education interventions not just to patients but to their families and the communities including barangay healthcare workers, midwives and nurses.

With the COPD guidelines now in place, Dr. Fernandez said that this guarantees the achievement of positive patient outcomes so they could have a better quality of life.

The group assures the public that the medical community’s various societies are working together to ensure that COPD patients are managed with equitable and relevant treatment options.

Aside from the COPD guideline, the group is expected to look into crafting a guideline on the overlapping of asthma cases with COPD as suggested by Dr. Ong-Dela Cruz.

The PCCP hopes that these efforts will be formalized soon with the support and representations from the government, in the context of Universal Health Care.

A complete copy of the COPD guideline can be viewed at www.philchest.org.

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