Vitacca Michele, Beccaria Massimiliano, Bianchi Luca, Ceruti Paolo, Marvisi Maurizio, Betti Monia, Bezzi Michela, Tursi Francesco
Respiratory Rehabilitation Unit, Istituti Clinici Scientifici Maugeri IRCCS, Institute of Lumezzane (Brescia), Italy.
Pulmonology Unit, Poma Hospital Mantua.
Multidiscip Respir Med. 2025 May 16;20(1):1023. doi: 10.5826/mrm.2025.1023.
Despite the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines providing a detailed pathway for the management of chronic obstructive pulmonary disease (COPD), the Italian reality is characterized by underdiagnosis, organizational disharmony, and poor adherence to treatments. COPD entails significant economic and organizational costs, including healthcare expenses, delayed diagnoses, and fragmented management. Therapeutic approaches are often non-standardized and influenced by local practices.
The audit presented here aims to provide suggestions to optimize COPD patient management, from the acute phase to stabilization, focusing on diagnosis, therapies, respiratory rehabilitation and follow-up, while proposing a coordinated pathway that could optimize patients and healthcare needs.
Eight specialists (1 internist and 7 pulmonologists) with extensive professional experience participated in the audit meetings. During three 4-hour sessions spread over three months, participants discussed background information, challenges and suggestions related to disease management. Topics were presented by designated leads, discussed by the group, and summarized into suggestions voted on using a Delphi-like process. Suggestions were approved if at least 75% of participants rated them above seven out of ten. The process produced a final list of shared suggestions. The audit group highlighted that the current management approach for COPD -patients-both in the stable phase and during exacerbations requiring hospital admission, discharge, and post-acute respiratory rehabilitation-remains fragmented, inconsistent, and poorly standardized. The group approved 29 improvement suggestions (21 achieved unanimous approval) across six main areas: a) The pathway for suspected or confirmed COPD patients; b) Therapy during the stable phase; c) Exacerbations/hospitalizations; d) Intensive care admissions requiring tracheostomy; e) Hospital discharge and f) Indications for respiratory rehabilitation.
This work offers a unique pulmonologist's point of view and suggestions based on literature, best practices, and field experiences to improve collaboration among stakeholders and provide more effective care for COPD patients.
尽管慢性阻塞性肺疾病全球倡议（GOLD）指南为慢性阻塞性肺疾病（COPD）的管理提供了详细路径，但意大利的实际情况是诊断不足、组织不协调以及对治疗的依从性差。COPD带来了巨大的经济和组织成本，包括医疗费用、诊断延误和管理分散。治疗方法往往不规范，且受当地做法影响。
本文介绍的审核旨在提供建议，以优化COPD患者从急性期到病情稳定阶段的管理，重点关注诊断、治疗、呼吸康复和随访，同时提出一条可优化患者和医疗需求的协调路径。
八位具有丰富专业经验的专家（1名内科医生和7名肺科医生）参加了审核会议。在为期三个月、分三次进行的每次4小时会议期间，参与者讨论了与疾病管理相关的背景信息、挑战和建议。由指定负责人介绍主题，小组进行讨论，并通过类似德尔菲法的流程将其总结为供投票的建议。如果至少75%的参与者将建议评为十分制中的七分以上，则建议获得批准。该流程产生了一份最终的共同建议清单。审核小组强调，目前COPD患者在稳定期以及需要住院、出院和急性呼吸康复后的加重期的管理方法仍然零散、不一致且标准化程度低。该小组在六个主要领域批准了29条改进建议（21条获得一致通过）：a）疑似或确诊COPD患者的路径；b）稳定期治疗；c）加重期/住院治疗；d）需要气管切开术的重症监护病房入院；e）出院；f）呼吸康复指征。
这项工作基于文献、最佳实践和实地经验，提供了独特的肺科医生观点和建议，以改善利益相关者之间的协作，并为COPD患者提供更有效的护理。
