Provider Tips

Promoting Guidelines-based Care

Promoting and following guidelines-based care ensures that Vermonters with COPD are appropriately diagnosed and get the care they need.

The COPD National Action Plan is the first-ever blueprint for a multi-faceted, unified fight again COPD, providing guidance and information on building awareness, improving care, and turning policy to action.

The Global Initiative for Chronic Obstructive Lung Disease (GOLD) Global Strategy for Prevention, Diagnosis and Management of COPD: 2025 Report outlines evidence-based strategies for COPD. A quick-reference guide is also available for physicians and nurses with key information about patient management and education.

The American Lung Association hosts an on-demand COPD Educator Course for respiratory therapists, internal medicine nurses, pulmonary nurses, pharmacists, and care managers.

COPD Prevention, Diagnosis and Treatment

Prevention

Knowing who is at highest risk of developing COPD is a first step in providing prevention guidance and referrals. See the COPD: Chronic Obstructive Pulmonary Disease section to determine highest risk groups for COPD in Vermont.

Diagnosis

An early diagnosis is important to slow progression of COPD by getting patients on treatment and self-management plans and to avoid preventable emergencies. People who are at high risk of COPD and who also have early warning signs and symptoms (a lingering cough, difficulty breathing, fast worsening symptoms), should be screened for COPD. It is important that any prior diagnosis of COPD is confirmed by performing or seeing the results of spirometry or chest imaging.

Key action: Confirm a COPD diagnosis with a pulmonary function test (PFT), including evaluating with spirometry.

Spirometry remains the gold standard for diagnosing COPD.

COPD Follow-up Care

Regularly scheduled follow-up care promotes stable COPD and reduces COPD-related emergencies. For patients at risk of exacerbation or for those who recently had a COPD-related emergency, more frequent follow-up care is essential for up to at least six months to ensure COPD is stabilized.

Vermont COPD Resources

COPD Action Plan

A COPD Action Plan is a written communication tool that health care providers fill out together with a patient to be used to guide and educate patients, family members, and their caregivers on daily self-management, and steps to take with worsening symptoms to keep their COPD stable, and when to seek emergency help.

Patients should be given an up-to-date COPD Action Plan with current medications and provider instructions every 12 months or at every significant adjustment in the treatment plan.

Complete a COPD Action Plan and Management Plan together with your patients.

COPD Action Plans are helpful tools for guiding patients to self-monitor and manage their COPD. Your health system might have their own tool, or you can download the Vermont COPD Action Plan.

Breathe Easier – Together

Three COPD booklets have been prepared to support Vermonters impacted by COPD, their families and caregivers, and primary care providers who prevent, treat and care for those with COPD to help “Breathe Easier – Together”:

COPD – A Workbook for Vermont Patient’s Families and Caregivers

COPD – A Guide for Supportive Therapies

COPD – A Provider’s Guide

Distribute these tools to your health care team members and to the first two to your patients.

To request additional copies of any of these booklets and the COPD Action Plan please email: AHS - VDH COPD Program [email protected].

Common Patient Challenges

Proper Device Use

One of the main challenges for patients is proper device use that prevents medications from getting into the lungs. COPD patients may have difficulty with:

timing and technique
holding one’s breath for a count of ten
confusing the type of medication or device
not monitoring the dose counter
not continuing to take their medications when feeling good, and
not picking up or refilling prescriptions.

Be sure to review with your patient the differences in types of medications and how to use each device correctly.

TIP!: A patient “show-back” is the best way to confirm proper device use. Do this for each device! Provide coaching to correct improper device techniques.

Spacers and Nebulizers

Some patients may need to be prescribed a spacer or nebulizer to ensure sufficient medications get to the lungs, especially if they have some of the challenges with inhaler use listed above. Review proper use of each device!

Oxygen Tanks, Non-Invasive Ventilators

If a patient is prescribed supplemental Oxygen Therapy – consider the type of oxygen delivery device that best meets the needs and lifestyle of your patients with COPD; and similarly with any non-invasive ventilators or other prescribed device.

Medication types, purposes, and barriers

A common challenge is that patients confuse types of medications and devices. Review each type of medication and its purpose (e.g., reduces inflammation and mucus development, and opens the airways, relaxes the muscle bands around airways). Use device posters or have patients bring their medications to each check-in to review.

Some patients do not pick up or refill prescribed medications or devices. Discuss barriers and possible solutions to improve “adherence” to their treatment plan, such as the cost of medications, difficulty with transportation or access to a pharmacy.

Referrals are Key to Comprehensive COPD Care and Team Coordination

Collaboration and strong referral linkages between multiple health care professionals, COPD patients, and their caregivers is crucial for comprehensive and effective COPD care. A team of health care professionals might include a primary care provider, physicians, pulmonologist, nurse (RN), nurses, respiratory therapist (RT), physical therapists (PT), care coordinators, nutrition specialist, mental health worker, and family members and other caregivers you rely on and who support you in managing your COPD. Together patients can receive the support, knowledge and skills they need to prevent developing COPD, slow disease progression if diagnosed, and help to manage their symptoms, reduce their risk of exacerbation, and improve their quality of life. Some examples of important referral linkages include the following:

Pulmonary Rehabilitation (Pulmonary Rehab)

Pulmonary rehabilitation is supervised exercise that may be needed to strengthen lung capacity, help stabilize your COPD, provide supplementary education around COPD self-management, and help you focus on supports to help maintain your quality of life. Pulmonary Rehab is recommended for those at risk for exacerbations. Some programs might also provide supplemental self-management education and additional health supports to help stabilize patients and avoid emergency exacerbations, including help with more advanced therapies. Click on this link for information on billing and coding for Pulmonary Rehab Services.

Refer patients to pulmonary rehabilitation program to help improve lung function.

According to the National Institutes of Health, pulmonary rehabilitation can help reduce COPD symptoms, increase physical activity, improve daily life function, and improve emotional health.

Smoking/Vaping Cessation

Quitting use of tobacco products, or never starting, is the best way to prevent COPD. As health care professionals, you can ensure that your patients are counselled, treated and/or referred to the support they need to quit use of tobacco or vaping products, including free nicotine replacement therapy options and smoking cessation supports. Knowing your patient’s total pack-years will help with treatment and referral planning.

Tip! Quitting smoking results in immediate benefits to lung health, even for those with COPD. Encourage smoking cessation!

Make referrals to a smoking cessation counselor in your area, or 802Quits.org or 1-800-QUIT-NOW.

Refer to 802Quits for quitting use of nicotine and tobacco products.

Quitting use of tobacco products is one of the most important steps toward preventing and managing COPD. 802Quits – Vermont’s 24/7 quitline – provides a range of free evidence-based tools and services to support individuals ready to quit any nicotine or tobacco product.

Vaccinations

Staying up-to-date on vaccines (such as a flu (influenza), respiratory syncytial virus (RSV), pneumococcal, COVID-19) adds important protection for your patients’ health and COPD management. Health care professionals can increase vaccine confidence by listening to concerns and offering accurate information to answer questions.

Manage co-morbidities

Individuals with COPD are also likely to have co-morbidities, particularly, depression, asthma, arthritis and heart disease. Vermont offers free, online healthy lifestyle workshops created by the Centers for Disease Control (CDC) and led by local health coaches through MyHealthyVT.org. Workshops are available on a variety of topics and conditions, including prediabetes, diabetes, high blood pressure, tobacco use and chronic disease and chronic pain management.

Advanced Therapies and Care

Some patients as they continue through the stages of disease progression will require more advanced therapies. It is important for each health care system and practice to maintain robust referral networks and protocols to ensure comprehensive care for COPD patients, especially as they progress to later stages of COPD. Care Coordinators for advanced care supports are essential to help patients, families and caregivers navigate through these advanced therapies and additional complex health care systems.

Some advanced therapies might include daily Azithromycin, Roflumilast, Endobronchial valve, Home non-invasive ventilation, and lung transplantation, but may also involve hospice, palliative care, home health services, and surgical options. Review these various advanced COPD therapies as soon as is reasonable to ensure sufficient time for decision-making, processing and making necessary arrangements.

Refer your patient for support in completing and registering an Advance Directive – a written document that outlines an individual’s wishes for medical treatment in the future, including if they are no longer able to make those decisions. Health care professionals can also learn more about applying for authorized access and Do Not Resuscitate orders.

Tip!: Encouraging patients to identify priority goals and “bucket lists” of things they would like to accomplish as they enter more advanced stages of COPD can provide valuable health-promoting motivation and general health support. Suggesting that they discuss these goals with family and friends to help support them to achieve their goals can also be positive.

See also Advanced COPD Therapies [link to new page?]

Other referrals

As a health provider you might also consider other referrals, within or outside of your health system where such services are available, including some of the following:

Nutritional/dietary supports
Stress/anxiety/mental health screening and supports
Supplementary COPD patient education
Home visiting to address environment triggers

COPD Quality Improvement (QI) Metrics

The following are examples of QI Metrics that might be integrated into your health care system to monitor efforts to strengthen COPD care and management.

Reduce the number of COPD 30-day hospital readmissions.
Increase the number of individuals diagnosed with COPD through spirometry or chest imaging.
Increase the number of individuals diagnosed with COPD who are referred to pulmonary rehabilitation.
Increase the number of individuals diagnosed with COPD who have an up-to-date COPD Action Plan.
Increase the number of individuals with COPD who are referred to 802Quits or other smoking/vaping cessation.

Are you interested in implementing COPD-related quality improvement (QI) initiatives at your organization? Email [email protected] to learn more.