Impact of interdisciplinary chronic obstructive pulmonary disease (COPD) management on patient quality of life

Purpose: To determine whether COPD disease state management, as part of an interdisciplinary pulmonary clinic, improves patient quality of life as measured by the COPD Assessment Test™ Score (CAT™ score).

Methods: This is a prospective study of patients with COPD receiving interdisciplinary management through a focused pulmonary team within a family medicine residency clinic. The pulmonary team consists of an attending faculty physician, a pharmacy resident, a faculty pharmacist, and a nurse. Patients receive one-on-one disease state education and knowledge assessment, inhaler instruction and evaluation, smoking cessation counseling and pharmacotherapy (if applicable), spirometry (if appropriate) and medication optimization. As part of symptom assessment, study subjects complete the CAT™ at the initial encounter and again at a follow up encounter at least four weeks following the initial assessment. The CAT™ measures the impact of COPD on a patient’s health status with a score ranging from 0 to 40 (>30=very high impact, >20=high impact, 10-20 medium impact, <10=low impact). Change in overall mean CAT™ score from initial visit to follow up assessment will be compared using Wilcoxon Signed Rank Test.

Results: To date, nine patients have completed the initial CAT™ and three patients have completed a follow up CAT™. Mean age of patients in the initial group is 58 years with over half being female and current smokers with a pack-year history of 29. Mean CAT™ score at initial assessment is 20.

Conclusion: Based on the preliminary data, CAT™ scores improved. This improvement may be due to more appropriate medication use, close follow up and/or better understanding of COPD and its management. We expect to see similar results with the other seven patients and with future patients enrolled.