1. First World Conference of COPD Patients The COPD Patient at the Crossroads 14 giugno 2009 - Roma Prof. Lorenzo Corbetta Firenze lorenzo.corbetta@unifi.it Implementation of Effective COPD Management Programs

2. GOLD Executive Committee Roberto Rodriguez-Roisin, MD – Chair Klaus Rabe, MD, PhD – Co-Chair PROGETTO MONDIALE BPCO Struttura Science Committee Klaus Rabe, MD, PhD - Chair Dissemination/Implementation Task Group Christine Jenkins, MD - Chair GOLD National Leaders - GNL

3. RATIONALE Evidence is increasing that a chronic disease management program for COPD patients that incorporates a variety of interventions, includes pulmonary rehabilitation, and is implemented by primary care reduce hospital admissions and bed days. Key elements are patient participation and information sharing among health care providers Rea H, McAuley S, Stewart A, Lamont C, Roseman P, Didsbury P. A chronic disease management programme can reduce days in hospital for patients with chronic obstructive pulmonary disease. Intern Med J 2004;34(11):608-14.

4. MODELS OF LOCAL IMPLEMENTATION OF GOLD GUIDELINES: THE ITALIAN EXPERIENCE THE 10 KEY POINTS 1.Annual scientific meeting in order to discuss the International Guidelines every March as of 2002 2.Set up a joint project with the Italian Leaders of the main International guidelines regarding the field of Pneumology: GOLD, GINA, ARIA which is called LIBRA (Linee Guida Italiane BPCO, Rinite, Asma) 3.Close relationships with the Lung Societies, GPs Associations, Patients organizations 4.Organization of the WCD with the Italian Association of COPD Patients 5.Translation of all materials which can be freely accessed by specialists and GPs for educational purposes. 6.Website www.goldcopd.it and multimedial materials as well as the more traditional ones. 7.CME courses on COPD using the official GOLD and LIBRA materials 8.Program of Fund raising 9.Media to raise awareness of COPD 10.Official acceptance of LIBRA as a GARD participant.

5. 1.Annual scientific meeting in order to discuss the International Guidelines every march as of 2002 2.Set up a joint project with the Italian Leaders of the main International guidelines regarding the field of Pneumology: GOLD, GINA, ARIA which is called LIBRA (Linee Guida Italiane BPCO, Rinite, Asma) 3.Close relationships with the Lung Societies, GPs Associations, Patients organizations 4.Organization of the WCD with the Italian Association of COPD Patients 5.Translation of all materials which can be freely accessed by specialists and GPs for educational purposes. MODELS OF LOCAL IMPLEMENTATION OF GOLD GUIDELINES: THE ITALIAN EXPERIENCE THE 10 KEY POINTS

6. ANNUAL SCIENTIFIC MEETING It consists of 3 main parts –General discussion of the International guidelines in 3 different Working Groups (GOLD, GINA, ARIA) with the aim of adapting the international guidelines to make them suitable in the national context. –Presentations given by the national and international outstanding experts in COPD who have been invited to present the data which has led to the new recommendations with subsequent question and answer session. –Presentation of the first draft of the Italian guidelines involving all Workshop participants

8. Chairman: Susan Hurd

9. lobal Initiative for Chronic bstructive ung isease GOLDGOLD GOLDGOLD PROGETTO MONDIALE BPCO

10. 1.Annual scientific meeting in order to discuss the International Guidelines every march as of 2002 2.Set up a joint project with the Italian Leaders of the main International guidelines regarding the field of Pneumology: GOLD, GINA, ARIA which is called LIBRA (Linee Guida Italiane BPCO, Rinite, Asma) 3.Close relationships with the Lung Societies, GPs Associations, Patients organizations 4.Organization of the WCD with the Italian Association of COPD Patients 5.Translation of all materials which can be freely accessed by specialists and GPs for educational purposes. MODELS OF LOCAL IMPLEMENTATION OF GOLD GUIDELINES: THE ITALIAN EXPERIENCE THE 10 KEY POINTS

12. www.progettolibra.it

15. 1.Annual scientific meeting in order to discuss the International Guidelines every march as of 2002 2.Set up a joint project with the Italian Leaders of the main International guidelines regarding the field of Pneumology: GOLD, GINA, ARIA which is called LIBRA (Linee Guida Italiane BPCO, Rinite, Asma) 3.Close relationships with the Lung Societies, GPs Associations, Patients organizations 4.Organization of the WCD with the Italian Association of COPD Patients 5.Translation of all materials which can be freely accessed by specialists and GPs for educational purposes. MODELS OF LOCAL IMPLEMENTATION OF GOLD GUIDELINES: THE ITALIAN EXPERIENCE THE 10 KEY POINTS

17. 1.Annual scientific meeting in order to discuss the International Guidelines every march as of 2002 2.Set up a joint project with the Italian Leaders of the main International guidelines regarding the field of Pneumology: GOLD, GINA, ARIA which is called LIBRA (Linee Guida Italiane BPCO, Rinite, Asma) 3.Close relationships with the Lung Societies, GPs Associations, Patients organizations 4.Organization of the WCD with the Italian Association of COPD Patients 5.Translation of all materials which can be freely accessed by specialists and GPs for educational purposes. MODELS OF LOCAL IMPLEMENTATION OF GOLD GUIDELINES: THE ITALIAN EXPERIENCE THE 10 KEY POINTS

23. World Asthma Day organized by LIBRA

24. 1.Annual scientific meeting in order to discuss the International Guidelines every march as of 2002 2.Set up a joint project with the Italian Leaders of the main International guidelines regarding the field of Pneumology: GOLD, GINA, ARIA which is called LIBRA (Linee Guida Italiane BPCO, Rinite, Asma) 3.Close relationships with the Lung Societies, GPs Associations, Patients organizations 4.Organization of the WCD with the Italian Association of COPD Patients 5.Translation of all materials which can be freely accessed by specialists and GPs for educational purposes. MODELS OF LOCAL IMPLEMENTATION OF GOLD GUIDELINES: THE ITALIAN EXPERIENCE THE 10 KEY POINTS

25. Workshop Report 2008 Executive Summary 2008 Pocket Guide 2008 Educational Slide-kit Patient Guide

26. Newsletter speciali Progetto Libra

27. INITIATIVES FOR COPD PATIENTS COPD PATIENT DIARY Its a booklet for COPD patients which : Describes the condition and how to live with it Makes it possible to record patient details such as: symptoms, respiratory function, exacerbations and treatment with the aim of: 1.Making the patient more aware of his/her condition 2.Making it possible to monitor the progression of the illness 3.Improving communication between the GP and the specialist

28. COPD PATIENT DIARY

29. www.admitonline.info

31. COPD Flash Inhalation treatment to reach therapy objectives Scenario: a 56 year old patient with COPD experiences coughing and dyspnea when he goes up the stairs or when carrying the shopping. He frequently uses bronchodilators as relievers as much as ten times a day and cough syrup. He frequently has a worsening of coughing with phlegm and dyspnea. Due to his ill health he often has to take time off work and risks losing his job for this reason. The scene shows the man out of puff and with a grey complexion climbing the stairs and when he gets to the top of the stairs he incorrectly uses his bronchodilator and resigns himself to the fact that he will never get better. Worried that his medication is finished he makes an appointment with his family doctor to have a repeat prescription. Scene 2: the patient enters the doctors surgery and complains to his doctor that his medication isnt working. If you were the doctor what would you do? a. repeat the usual prescription b. ask if patient is exposed to risk factors c. admit the patient to hospital Educational message : the most important thing is to further investigate to find out if the patient is smoking or exposed to other risk factors. The elimination of risk factors is the key to improving patient health Scene 3: Patient stopped smoking 5 years before. If you were the doctor what would you do? a.Repeat the usual prescription b.Establish the severity of the disease c.Admit the patient to the hospital Educational message: in a COPD patient the treatment prescribed must be based on the severity of the disease. Show the classification of COPD based on spirometry and ABG

32. COPD Flash Inhalation treatment to reach therapy objectives Scene 4: doctor performs and/or requests a spirometry and a ABG analisys to be compared with previous results and concludes that there is no variation. If you were the doctor what would you do? a. Check compliance and inhalation technique b. Repeat the usual prescription c. Admit the patient to hospital Educational message: the key to obtaining good results with pharmacologic therapy in patients with COPD is to take therapy regularly over a long period of time. In fact the most important trials have shown an improvement of symptoms and exercise tolerance, reduction of exacerbation, improved quality of life over a period of several years of treatment. Constant monitoring of inhalation technique is an essential part of pharmacotherapy Scene 5: What should you do if your patient is unable to use the prescribed treatment correctly? a. Prescribe only medication which is to be taken orally b Prescribe a more appropriate device based mainly on coordination and maximum inhalation flow c. Prescribe only a nebulizer Educational message: doctors have to choose the right device to suit each individual patient. (Show the flow- chart for making the right choice) Scene 6: If the patient continues to complain about his symptoms a.Check for comorbidities b.Prescribe oral corticosteroids c.Admit patient to hospital Educational message: patients who are elderly and smokers or ex smokers often suffer from comorbidities such as chronic cardiac failure, hypertension, diabetes, osteoporosys, metabolic syndrome etc that complicate their condition Scene 7: And what is the final recommendation? a. Maintain a regular diet and exercise routine b. Prescribe a rehabilitation program c. Give the patient a written plan and arrange regular follow-up appointments d. All Show the doctor that explain to the patient the flow chart to reach therapy objectives

33. Decisional Support within the Electronic Clinical Record for GPs

36. First World Conference of COPD Patients The COPD Patient at the Crossroads 14 giugno 2009 - Roma Prof. Lorenzo Corbetta Firenze lorenzo.corbetta@unifi.it Implementation of Effective COPD Management Programs Thank you for joining us here in Rome!