Reducing COPD Re-Admissions Through Support And Prevention

Community Acquired Pneumonia (CAP) and Chronic Obstructive Pulmonary Disease (COPD) pose significant challenges worldwide, accounting for approximately 20 percent of deaths in Singapore and being the leading causes of hospital admissions. To maximize resources and expertise, an extensive program called The Airway Programme (TAP) has been implemented urgently.

CAP and COPD are big problems globally. In Singapore, they cause about 20% of deaths and lead to many hospital admissions. The Airway Programme (TAP) brings together resources and knowledge to help patients get better. At the National University Hospital (NUH) Emergency Medicine Department, all patients with CAP or COPD will be evaluated to see how serious their condition is and if they need to stay in the hospital.

TAP aims to optimize patient outcomes by merging the management of both conditions. At the National University Hospital (NUH) Emergency Medicine Department, all patients diagnosed with CAP or COPD will undergo immediate assessment for clinical severity and urgent determination of hospitalization requirements.

Patients categorized as low risk for CAP who are selected for home care will receive antibiotic treatment and have an outpatient appointment scheduled in two weeks’ time. The team will also provide ongoing support through phone calls and home visits, if necessary. In case there is no improvement in the patient’s condition or if symptoms persist, readmission to the hospital will be arranged. 

On the other hand, high-risk patients will be directly admitted to the hospital for treatment. The assessment process for COPD patients will be uniformly applied across all cases. Those identified as low-risk individuals shall undergo an evaluation to explore potential options for receiving care at home while those deemed high-risk shall be admitted to the hospital without delay. Furthermore, all patients shall benefit from a comprehensive and customized patient education initiative designed specifically to enhance their overall well-being.

This initiative takes into account the needs of individuals by offering guidance on daily preventive treatments and self-management techniques such as utilizing a COPD action plan. Moreover, TAP participants can count on support in their journey to quit smoking, as well as access to pulmonary rehabilitation programs and essential vaccinations.

Aims of The Airway Programme:

• Halt the deterioration of the disease
• Relieve breathlessness and coughing symptoms
• Enhance performance in daily tasks and exercises
• Improve overall health status and extend lifespan
• Manage and prevent complications arising from the illness
• Treat periods of worsening condition effectively 
• Assist patients in successfully quitting smoking, as doing so significantly impacts the rate of respiratory disease progression. Although it is not possible to reverse existing damage to the airways, quitting smoking can prevent further decline regardless of when one decides to quit.

The TAP Programme strives to enhance patient care by implementing various tasks. These tasks encompass conducting thorough physical examinations to evaluate disease progression and assessing the safety of the patient’s living situation. 

Furthermore, educating patients and caregivers about COPD management strategies such as coping mechanisms, action plans, home exercises, and self-care practices plays a vital role in improving their well-being. It is equally important to guarantee that patients and caregivers have a clear understanding of medication regimes and techniques for optimal outcomes.

Moreover, the promotion of equipment maintenance for essential items like home oxygen supplies, neutralizers, and home ventilation systems significantly contributes to establishing a secure environment. To complete the Singapore hospital’s all-encompassing TAP Programme approach, Singaporean hospitals also offer counselling services to aid patients in their quest to quit smoking successfully. 

Whenever enrolled patients have questions or need support related to their illness, they can reach out to the case manager via phone call. This encompasses requests for prescriptions or appointment rescheduling and seeking advice on effectively managing their condition. As an additional gesture of care and appreciation towards our patients’ well-being, they will receive a bonus card for medication purchases.

The Case Manager’s role extends beyond regular responsibilities to proactively engage with patients in diverse circumstances. This includes offering gentle reminders for upcoming respiratory follow-up appointments, reaching out when a patient fails to attend an appointment, and providing valuable guidance during challenging times like influenza epidemics or haze conditions.

Additionally, the Case Manager takes great care in meticulously tracking vaccination dates and ensuring that all enrolled patients strictly adhere to their scheduled vaccination appointments. They actively guide patients towards specialized departments tailored to meet their individual needs, encompassing Medical Social Work, Home or Inpatient Palliative Care, and the esteemed Pulmonary Rehabilitation Programme.

Singapore’s COPD Care Services: Holistic Care for Patients’ Daily Living, Medication, and Emotional Needs.

COPD comprises a range of chronic lung diseases and respiratory conditions including chronic bronchitis and emphysema. In cases of bronchitis, there is inflammation and narrowing of the airways, resulting in frequent expectoration of phlegm among COPD patients. Conversely, emphysema involves progressive damage to lung tissue, specifically targeting the alveolar – small air sacs within the lungs. This damage eventually leads to their fusion into a single large air pocket instead of multiple smaller ones. 

Consequently, this reduction in lung surface area impairs airflow within the damaged tissue while impeding oxygen transport through the bloodstream. Further understanding of COPD can aid in developing effective treatments for individuals affected by this complex condition.

Individuals suffering from COPD face challenges in their lung function as their airways become constricted. This constriction occurs due to persistent inflammation, resulting in thickened and swollen airway walls, as well as the contraction of small muscles surrounding the airways. Moreover, excessive mucus production exacerbates the limitation of airflow. 

COPD patients can benefit from pulmonary rehab programs. These programs include exercise routines and educational sessions. The exercises are designed to help with physical activity and teach important skills like breathing techniques and stress management. The sessions also cover topics like healthy eating and using inhalers correctly. A comprehensive approach to managing COPD involves participating in a pulmonary rehab program that combines exercises and informative sessions. It includes personalized physical activities and teaches breathing techniques, stress management, healthy eating, and how to use inhalers and medications correctly.

Despite being an incurable condition, COPD can be effectively managed through various drugs that target the aforementioned factors. Additionally, individuals can improve their quality of life by making positive changes to their lifestyle such as quitting smoking, maintaining a balanced diet, and engaging in regular exercise. 

Supplemental oxygen therapy takes centre stage in the treatment of individuals facing advanced COPD and chronically low blood oxygen levels. This essential therapeutic approach can be implemented through diverse methods such as cylinders, liquid form, or a concentric device capable of extracting oxygen from the surrounding air. The primary cause behind COPD is commonly attributed to extended exposure to harmful substances like cigarette smoke, resulting in enduring lung damage.

CAP and COPD are major health concerns in Singapore, contributing to a significant number of deaths. By addressing these challenges head-on and implementing comprehensive measures, we can strive towards reducing the burden of respiratory diseases in Singapore and saving countless lives.