Chronic bronchitis and chronic obstructive pulmonary disease: Finnish National Guidelines for Prevention and Treatment 1998–2007

Abstract

• 1. A national recommendation for the promotion of prevention, treatment and rehabilitation in relation to chronic bronchitis and COPD from 1998 to 2007 has been prepared on the basis of extensive collaboration by order of the Ministry of Social Affairs and Health. The Programme needs to be revised as necessary, because of rapid developments in medical knowledge, and in drug therapy in particular.

• 2. COPD is a disease characterized by slowly progressing, irreversible airways obstruction. Over 5% of the population suffer from symptomatic forms of the disease. It is estimated that a further 5% of the population may suffer from latent COPD. Most patients (75%) suffer from mild forms of the disease. The disease is often preceded by chronic bronchitis. A total of 400 000 Finns suffer from chronic bronchitis or COPD. Occurrence of these diseases in future will be particularly affected by decreased smoking by men, increased smoking by the young and by women, and aging of the population.

• 3. In 1997, the annual treatment costs of chronic bronchitis and COPD were estimated to be FIM 1.5 thousand million, total costs FIM 5 thousand million. Without intensification of measures to prevent and treat the diseases, costs will rise significantly. Costs arising from severe COPD (5% of patients with COPD) account for roughly 65% of costs overall and are primarily related to hospitalizations.

• 4. The goals of the Programme for the Prevention and Treatment of Chronic Bronchitis and COPD are as follows: (a) to decrease the incidence of chronic bronchitis; (b) to ensure that as many patients as possible with chronic bronchitis recover; (c) to maintain capacity for work and functional capacity of patients with COPD; (d) to reduce the percentage of patients with moderate to severe COPD; (e) to decrease the number of hospitalization days of COPD patients by 25% overall; and (f) to decrease annual costs per patient.

• 5. The following means are suggested for achieving the goals: (a) reduction in smoking; (b) reduction in work-related and outdoor air pollutants and improvement of quality of indoor air; (c) enhancement of knowledge about risk factors and treatment of the diseases is in key groups; (d) promotion of early diagnosis and active treatment, in smokers in particular; (e) improvement of guided self-care; (f) early commencement of rehabilitation, individual planning and implementation, primarily as an element in treatment; and (g) encouragement of scientific research.

• 6. COPD and exacerbation of its symptoms can be prevented through choices relating to life habits, such as not smoking, maintaining good general condition, and protection against exposure to dusts. The Programme gives examples of such measures and appeals to various authorities and voluntary organizations to increase their cooperation. Preventive methods should be individualized, and based on due consideration.

• 7. Chronic bronchitis and COPD should be diagnosed at early stages, and treated appropriately from the outset. Treatment consists of: (a) treatment according to causes, such as stopping smoking and work hygiene; (b) early rehabilitation such as patient education and guided self-care; (c) drug therapy; (d) hospital treatment; and (e) rehabilitation.

• 8. The hierarchy of referrals in the treatment of COPD should be revised to accord a greater role to the primary health care sector. Good exchanges of information and cooperation between the primary health care and specialized medical care sectors will all be necessary if this hierarchial model is to have the desired effect.

• 9. Hospital districts and health centres should ensure that different levels of the health-care system are capable of fulfilling the tasks assigned to them appropriately. One specialist in each hospital district should be given charge of prevention and assembly of know-how relating to treatment, and of quality of treatment at regional level. In the primary health care sector, contact individuals should be appointed to disseminate information, coordinate training and promote cooperation with, for example, dental-care personnel. It would be best if individuals in charge and acting as contacts were the individuals responsible for the National Asthma Programme. Prevention and treatment of chronic bronchitis and COPD should be matters for regional cooperation.

• 10. Rehabilitation of patients with chronic bronchitis or COPD should cover all forms of rehabilitation: medical, occupational and social. Rehabilitation should prevent exacerbation of disease, support self-care, increase patient resources and improve quality of life, reducing needs for hospitalization. Early rehabilitation should be increased, and guidance and advice should form integral elements in treatment. Rehabilitation should be implemented on an outpatient basis as far as possible.

• 11. Information and training should be directed primarily towards key groups, such as patients and their families, health-care personnel, and individuals responsible for environmental issues. Organizations should disseminate information to members and, if necessary, produce general material needed for health and patient education relating to chronic bronchitis and COPD, and training material, in cooperation with the authorities. The Social Insurance Institution should disseminate information about reimbursement for medicines and social security. The pharmaceutical industry and pharmacies will play key roles in supporting information and training. Regional direction and training will be the responsibilities of hospital districts, provincial governments and local health centres. The Ministry of Social Affairs and Health will also be responsible for implementation of the Programme, its follow-up and, if necessary, its revision. The media will play an important role in the dissemination of in-depth information about prevention and treatment of COPD.

• 12. Research should focus on: (a) population studies on prevalences of the diseases, risk groups and risk factors; and (b) studies aiming at improvement of prevention and guided self-care.

• 13. If the Programme for the Prevention and Treatment of Chronic Bronchitis and COPD for 1998–2007 is implemented, the increasing numbers of patients who will suffer from COPD will be treatable at current costs. If not, costs paid by society will increase rapidly. Implementation of the Programme will not result in significant additional costs. The costs of initiating the Programme will be approximately FIM 5 million.