Advanced chronic obstructive pulmonary disease: rethinking models of care

Chronic obstructive pulmonary disease (COPD) is unique among leading causes of death in western society. Prevalence, associated morbidity and attributable mortality continue to rise. The resultant cost in quality of life to patients, families and to the health care system in general, demands improvements in the prevention and treatment of this common and ultimately debilitating condition. Traditional healthcare approaches to COPD, based on the biomedical model, have focused on the underlying pathophysiology of disease within which patients receive episodic care aimed at treating and preventing acute exacerbations. In contrast, patients living with COPD interpret it from an individually experienced illness perspective impacted by unique contextual factors that influence personal meaning. The psychosocial ramifications that follow the inexorable decline in capacity and independence are powerful forces shaping the experience of patients living with advancing COPD. The dominant role and impact of psychosocial effects on quality of life in advancing COPD require us to rethink our approach to care to more effectively address these more elusive yet chronically troublesome issues.