5.8.6. Future developments

Higher standards of COPD care and studies on the effectiveness of current prevention, education, medication and rehabilitation need to be established.

Caregivers and patients need to be guided towards the most efficient and effective ways to manage this disease. Further studies on the influence of genetic factors, exacerbations, comorbidities, natural history, deaths and costs are necessary to contrast the increasing health and economic burden of COPD.

Some new broncodilators, inhaled steroids and selective phosphodiesterase 4 inhibitors are in the late phases of clinical trials. New evidence is being acquired on the effectiveness on symptoms and mortality rate of non invasive mechanical ventilation.

New sophisticated technologies including telecare systems and stand-alone electronic devices capable of supporting older people at home have been widely advertised although larger studies are still needed (Horton, 2008).

Moreover, some aspects of COPD health care should also be also taken into consideration.

The use of telecare aimed at helping older people to remain independent at home, reduce hospital admissions and improve the quality of life should be implemented in COPD patients.

Previous studies have documented similar levels of end-of-life symptom burden for lung cancer and chronic obstructive pulmonary disease (COPD) patients, yet there has been little comparison of health care utilization during this period. Goodridge et al (2008) showed that in the last 12 months of life, decedents with COPD were more likely to be institutionalized in a long term care setting (41% vs. 12.5%, p<0.05) and to receive long-term home care (26% vs 9.7%, p<0.05), but were much less likely to receive palliative care in hospital (47.6% vs 5.1%, p<0.001) or at home (37.4% vs 2.8%, p<0.05) than people with lung cancer. Patients with COPD generally have limited access to enriched resources available through palliative care programs, partially due to the difficulty in prognosis. The development of new and more responsive models of end-of-life care for this population will be contingent upon understanding current patterns of health care utilization.