Chronic Care Management (99490) for Chronic Obstructive Pulmonary Disease (COPD)

Chronic obstructive pulmonary disease (COPD) is a serious lung disease and the third leading cause of death in the United States ⁽¹⁾. More than 11 million people have been diagnosed with COPD, but millions more may have the disease without even knowing it ⁽¹⁾. Low health literacy, economic hardships, and comorbidities at times prevent Chronic Care Management patients with COPD from leading better lives. The variation of needs in COPD Management calls for continuity and flexibility of care to allow both health care providers and patients to respond to the increasing demands of the disease over time. Chronic Care Management participants should benefit from diagnosis-related education and patient-specific resources for lifestyle modifications, including smoking cessation, which can improve quality of life and independence.

CCM Related Education for COPD

COPD is often not diagnosed until the disease is very advanced because patients are unaware of the early warning signs ⁽¹⁾. According to the American Lung Association, sometimes patients think they are short of breath or less able to take part in their normal activities because they are “just getting older. ⁽¹⁾” Caregivers’ challenges often echo patients’ challenges, and include anxiety, depression, difficulty maintaining employment, loss of mobility, and social isolation. Common pulmonary symptoms noted by patients diagnosed with COPD include the following:

• Shortness of breath, especially during physical activities
• Wheezing
• Chest tightness
• Having to clear your throat first thing in the morning, due to excess mucus in your lungs
• Chronic cough that may produce mucus (sputum) that may be clear, white, yellow or greenish
• Blueness of the lips or fingernail beds (cyanosis)
• Frequent respiratory infections
• Lack of energy
• Unintended weight loss (in later stages)
• Swelling in ankles, feet or legs⁽²⁾

According to the previous potential complaints, Chronic Care Management coordinators should be thorough and routinely assess for changes in their respiratory status, activity tolerance, and mental health. There is no cure for COPD, but it can be managed well with medications, oxygen therapy, and pulmonary rehabilitation. Chronic Care Management coordinators should be patients’ advocates and help maintain medication adherence, appointment compliance, and oxygen accessibility.

CCM Related Resources for COPD patients

Some symptoms associated with COPD hinder patients from completing simple daily tasks without assistance. The COPD CCM patients often need additional sources of emotional support and coping such as COPD Foundation as well as the American Lung Association. Caregivers should be encouraged to express changes and/or concerns for those impacted by COPD. There are numerous resources and lifestyle modifications that can have a positive impact on COPD such as, but not limited to, the following:

• Exercise training
• Nutritional counseling
• Education on COPD
• Energy-conserving techniques
• Breathing strategies
• Psychological counseling and/or group support
• Smoking cessation counseling

In addition to the above resources, patients should have their individual concerns and/or needs addressed. Impairments with activities of daily living and/or financial strains may be areas that require attention. Chronic Care Management patients should receive assistance with obtaining resources required to lessen symptoms of COPD and furthermore reduce emergency room visits and heath care costs.

CCM, COPD, and Smoking Cessation

The Centers for Disease Control and Prevention reports smoking accounts for as many as 8 out of 10 COPD-related deaths ⁽³⁾. Additional findings by the Centers for Disease Control and Prevention reflect the following:

• In women, smokers are 13 times more likely to die from COPD than non-smoking women.
• For men, smokers are 12 times more likely to die from COPD than their non-smoking counterparts.⁽⁴⁾

Based upon these findings, it is imperative that Chronic Care Management patients receive necessary information and support for smoking cessation. Smoking cessation and avoiding exposure to smoke are primary interventions to control the course of COPD.  Assistance obtaining local resources at health departments, hospitals, and/or provider offices should be discussed and considered to ultimately prevent further lung damage and improve participation in daily activity for Chronic Care Management patients living with COPD.

References

1. American Lung Association. American Lung Association. [Online] 2016. [Cited: November 16, 2016.] http://www.lung.org/lung-health-and-diseases/lung-disease-lookup/copd/learn-about-copd/how-serious-is-copd.html?referrer=https://www.google.com/.
2. Mayo Clinic. Mayo Foundation for Medical Education and Research. [Online] 1998-2016. [Cited: November 16, 2016.] http://www.mayoclinic.org/diseases-conditions/copd/home/ovc-20204882.
3. Centers for Disease Control and Prevention. Centers for Disease Control and Prevention. [Online] January 18, 2016. [Cited: November 16, 2016.] http://www.cdc.gov/tobacco/campaign/tips/diseases/copd.html.
4. Centers for Disease Control and Prevention. Centers for Disease Control and Prevention. [Online] [Cited: November 16, 2016.] http://www.cdc.gov/nchs/data/series/sr_10/sr10_260.pdf.