An algorithm for the management of chronic obstructive pulmonary disease patients in units of internal medicine

Published: 17 February 2025
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Patients with acute exacerbations of chronic obstructive pulmonary disease (COPD) are often hospitalized in internal medicine units (IMUs), and their management is challenging due to a multiplicity of factors affecting the outcome, such as correct patient classification, appropriate pharmacologic therapy, patient discharge, and follow-up. In this context, a standardized pathway (algorithm) for the management of these patients was designed and tested. Specifically, based on information collected through a survey on the management of COPD patients in IMUs, an initial version of an algorithm was designed by the scientific board and proposed to 45 IMUs for a 6-month period to evaluate its feasibility, usefulness, and critical issues. After this preliminary phase, a second version was released, which was again brought to the attention of the participating centers, leading to the final algorithm. The algorithm reports the steps for the management of patients with severe exacerbations of known or suspected COPD, namely: correct diagnosis, treatment of the acute phase, management of comorbidities, appropriate therapy at discharge, and planning of the follow-up. Focus is given to the shift from systemic therapy in the acute phase to early in-hospital inhalation triple therapy (inhaled corticosteroids/long-acting muscarinic antagonists/long-acting β agonists) and the need for education in the use of the inhaler. The algorithm was considered useful by most of the participating centers. The proposed algorithm is an agile and usable tool for managing the main steps of care of COPD patients in IMUs. The future goal is to make the model available to a wider audience of internists.

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Citations

Stabile C, Para O, Tangianu F, et al. Management of COPD patients in the internal medicine operative units. Italian J Med 2021;15:9.
Rabe KF, Hurst JR, Suissa S. Cardiovascular disease and COPD: dangerous liaisons? Eur Respir Rev 2018;27:180057. DOI: https://doi.org/10.1183/16000617.0057-2018
Smith MC, Wrobel JP. Epidemiology and clinical impact of major comorbidities in patients with COPD. Int J Chron Obstruct Pulmon Dis 2014;9:871-88. DOI: https://doi.org/10.2147/COPD.S49621
Rogliani P, RitondoBL, Laitano R, et al. Advances in understanding of mechanisms related to increased cardiovascular risk in COPD. Expert Rev Respir Med 2021;15:59-70. DOI: https://doi.org/10.1080/17476348.2021.1840982
Bahadori K, FitzGerald JM, Levy RD, et al. Risk factors and outcomes associated with chronic obstructive pulmonary disease exacerbations requiring hospitalization. Can Respir J 2009;16:e43-9. DOI: https://doi.org/10.1155/2009/179263
Hurst JR, Donaldson GC, Je Quint JK, et al. Temporal clustering of exacerbations in chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2009;179:369-74. DOI: https://doi.org/10.1164/rccm.200807-1067OC
Bellaudi V, Di Martino M, Cascini S, et al. The impact of adherence to inhaled drugs on 5-year survival in COPD patients: a time dependent approach. Pharmacoepidemiol Drug Saf 2016;25:1295-304. DOI: https://doi.org/10.1002/pds.4059
Calzetta L, Ritondo BL, De Marco P, et al. Evaluating triple ICS/LABA/ LAMA therapies for COPD patients: a network meta-analysis of ETHOS, KRONOS, IMPACT, and TRILOGY studies. Expert Rev Respir Med 2021;15:143-52. DOI: https://doi.org/10.1080/17476348.2020.1816830
Lipson DA, Barnhart F, Brealey N, et al. Once-daily single-inhaler triple versus dual therapy in patients with COPD. N Engl J Med 2018;378:1671-80. DOI: https://doi.org/10.1056/NEJMoa1713901
Rabe KF, Martinez FJ, Ferguson GT, et al. Triple inhaled therapy at two glucocorticoid doses in moderate-to-very-severe COPD. N Engl J Med 2020;383:35-48. DOI: https://doi.org/10.1056/NEJMoa1916046
Papi A, Vestbo J, Fabbri L, et al. Extrafine inhaled triple therapy versus dual bronchodilator therapy in chronic obstructive pulmonary disease (TRIBUTE): a double-blind, parallel group, randomised controlled trial. Lancet 2018;391:1076-84. DOI: https://doi.org/10.1016/S0140-6736(18)30206-X
Ismaila AS, Haeussler K, Czira A, et al. Fluticasone furoate/umeclidinium/vilanterol triple therapy compared with other therapies for the treatment of COPD: a network meta-analysis. Adv Ther 2022;39:3957-78. DOI: https://doi.org/10.1007/s12325-022-02231-0
Wells JM, Criner GJ, Halpin DMG, et al. Mortality risk and serious cardiopulmonary events in moderate-to-severe COPD: post hoc analysis of the IMPACT trial. Chronic Obstr Pulm Dis 2023;10:33-45. DOI: https://doi.org/10.15326/jcopdf.2022.0332
Mannino D, Bogart M, Germain G, et al. Benefit of prompt versus delayed use of single-inhaler fluticasone furoate/umeclidinium/vilanterol (FF/UMEC/VI) following a COPD exacerbation. Int J Chron Obstruct Pulmon Dis 2022;17:491-504. DOI: https://doi.org/10.2147/COPD.S337668
Bogart M, Glassberg MB, Reinsch T, Stanford RH. Impact of prompt versus delayed initiation of triple therapy post COPD exacerbation in a US-managed care setting. Respir Med 2018;145:138-44. DOI: https://doi.org/10.1016/j.rmed.2018.10.013
Mainar AS, Huerta A, Artieda RN, et al. Economic impact of delaying initiation with multiple-inhaler maintenance triple therapy in Spanish patients with chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis 2019;14:2121-9. DOI: https://doi.org/10.2147/COPD.S211854
Global Initiative for Chronic Obstructive Lung Disease. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: 2023 report. Available from: https://goldcopd.org/2023-gold-report-2/.
Sanduzzi A, Balbo P, Candoli P, et al. COPD: adherence to therapy. Multidiscip Respir Med 2014;9:60. DOI: https://doi.org/10.4081/mrm.2014.395
Maria Sandra Magnoni, GSK Medical Department, Verona

Present address: GSK Medical Affairs Department, Verona, Italy

How to Cite

Para, O., Stabile, C., Cinquepalmi, D., Magnoni, M. S., Nasso, F., Tangianu, F., Silingardi, M., Valerio, A., Manfellotto, D., & Dentali, F. (2025). An algorithm for the management of chronic obstructive pulmonary disease patients in units of internal medicine. Italian Journal of Medicine, 19(1). https://doi.org/10.4081/itjm.2025.1838