The Philippine College of Chest Physicians (PCCP), along with its partner-institutions, has completed the local guideline for the management and treatment of Chronic Obstructive Pulmonary Disease (COPD) that already takes into consideration COVID-19 and ways to minimize out-of-pocket expenses of patients.
On Nov. 16, members of the Philippine College of Chest Physicians 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,” Dr. Fernandez, who heads the Pulmonary Medicine Division of the Philippine General Hospital, noted in a separate interview.
The experts emphasize the importance for the public to be aware of COPD and to be open in seeking medical intervention in case 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.
Thus, 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.
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 currently, there are 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.
The guideline also suggests effective strategies on the management of COPD which includes health education interventions directed to the patient, family, and the community. 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.
“All guidelines and similar documents are recommendatory, where intake of the recommendations is voluntary on the part of the recipient or healthcare giver,” she said during the convention.
“All interventions we considered were assessed according to their corresponding premium or their cost-effectiveness. Again, we try to simplify our treatment recommendations with an alternative, cheaper option always being in place,” she concluded. Meanwhile, Dr. Trinidad said studies are now being conducted on occupational COPD though it is still an emerging concept. Citing a prospective study published in Europe. Dr. Trinidad said there is significant data that industrial and biological dust, and other fumes can cause COPD thus the need for respiratory protective equipment in workplaces can be considered.
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.
Complete copy of the COPD guideline can be viewed at www.philchest.org.
What is COPD?
Chronic Obstructive Pulmonary Disease (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.