From acute phase to rehabilitation: bridging the gap and improving the pathway for Chronic Obstructive Pulmonary Diseases patients (Summary of a Pulmonologists' Audit - September-December 2024).

Abstract

Introduction: Despite the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines providing a detailed pathway for the management of chronic obstructive pulmonary disease (COPD), the Italian reality is characterized by underdiagnosis, organizational disharmony, and poor adherence to treatments. COPD entails significant economic and organizational costs, including healthcare expenses, delayed diagnoses, and fragmented management. Therapeutic approaches are often non-standardized and influenced by local practices.

Methods: The audit presented here aims to provide suggestions to optimize COPD patient management, from the acute phase to stabilization, focusing on diagnosis, therapies, respiratory rehabilitation and follow-up, while proposing a coordinated pathway that could optimize patients and healthcare needs.

Results: Eight specialists (1 internist and 7 pulmonologists) with extensive professional experience participated in the audit meetings. During three 4-hour sessions spread over three months, participants discussed background information, challenges and suggestions related to disease management. Topics were presented by designated leads, discussed by the group, and summarized into suggestions voted on using a Delphi-like process. Suggestions were approved if at least 75% of participants rated them above seven out of ten. The process produced a final list of shared suggestions. The audit group highlighted that the current management approach for COPD -patients-both in the stable phase and during exacerbations requiring hospital admission, discharge, and post-acute respiratory rehabilitation-remains fragmented, inconsistent, and poorly standardized. The group approved 29 improvement suggestions (21 achieved unanimous approval) across six main areas: a) The pathway for suspected or confirmed COPD patients; b) Therapy during the stable phase; c) Exacerbations/hospitalizations; d) Intensive care admissions requiring tracheostomy; e) Hospital discharge and f) Indications for respiratory rehabilitation.

Conclusions: This work offers a unique pulmonologist's point of view and suggestions based on literature, best practices, and field experiences to improve collaboration among stakeholders and provide more effective care for COPD patients.