COPD program can help improve productivity

Behavioral changes focus on initiative

A new disease management program being introduced by Health Management Corp. (HMC) will help improve quality of life for employees suffering from chronic obstructive pulmonary disease (COPD) and reduce expenses for their employers, says the Richmond, VA-based health and disease management company.

COPD, while a good deal less publicized than other chronic diseases, is the fourth-leading cause of death in the United States, ranking just behind heart disease, cancers, and stroke, according to the American Lung Association.

"Clinicians are familiar with COPD, but it is not given the same amount of publicity as other respiratory conditions," concedes Bob Kolock, MD, HMC’s medical director.

He explains that COPD is typically includes one of two conditions: emphysema and/or chronic bronchitis. "The nature of the chronicity is that it develops over time, and we typically start to see it in the older population," says Kolock.

Nevertheless, he says, COPD is very much an occupational health concern. "You need to look at it from two viewpoints," he says. "First, COPD is due to ongoing damage to lung tissue, and the primary source is smoking. Second, occupational hazards and irritants can also contribute to the disease. So, depending on the industry, employees can be exposed to irritants that lead to COPD." Kolock notes, however, that many of these irritants are hydrocarbons, and due to environmental laws exposures are "probably relatively rare in this day and age."

HMC’s COPD program will focus on smoking cessation, home oxygen therapy and optimizing physician-prescribed medications. The overall program is based on the Guidelines for COPD Management established by the Global Initiative for Chronic Obstructive Lung Disease, or GOLD. GOLD ( is a joint effort of the World Health Organization and the National Heart, Lung, and Blood Institute. Its multifaceted smoking cessation component is derived from U.S. Depart-ment of Health and Human Services guidelines.

The program follows the model HMC developed for its asthma, diabetes, coronary artery disease, congestive heart failure, and maternity programs. It features predictive modeling to identify participants most in need of nurse interventions and individualized patient management focused on behavior change.

"Certain medical claims indicate that a person has COPD," Kolock explains. "So first, we analyze claims to see which individuals have that diagnosis. Once we have the population, we apply a predictive model that allows us to stratify the population."

In other words, if a health plan member population is 500, the patients are ranked from one to 500, according to which of them are more likely to have complications over the ensuing 12 months. The goal is to match the high-intensity program with those who would most benefit. This would also have the greatest impact on health costs.

"The upper 15%-20% would be contacted. We’d explain the high-intensity program and seek their agreement to participate," says Kolock. Others who are not at such a risk for complications would get mailings on periodic basis, access to a 24-hour nurse line, and their claims will be reviewed on a monthly basis. The claims are regularly reviewed, Kolock explains, because individuals who are considered stable at first may later move into a riskier category.

The high-intensity program participants receive all of the information the others do, but they also will be contacted proactively. "They will have nurse care managers, based on their clinical needs, and a tailored program that compares where the patient is vs. where they should be," says Kolock. "For example, they may have stopped smoking five years ago, but the condition has advanced, in which case we may need to look at their medications. In another, they might still be smoking, so we’ll try to get them to stop."

The sobering truth about COPD is that you can’t reverse the disease. With progression of the disease comes an inevitable impact on productivity.

"This is an insidious disease," says Kolock, "But it has its exacerbations. A person who has chronic bronchitis is more of a setup to get acute infections of the lung, which affects absenteeism. Such a person also takes longer to recuperate."

Besides smoking cessation, are there other behavior changes that can help slow the progress of the disease? "That’s the big one," says Kolock. "The chance of getting COPD if you’re a smoker is 80%."

Since the disease cannot be reversed, the aim of the program is to optimize quality of life, both at work and at home.

"Meds do help control the symptoms," says Kolock, noting than many are bronchodilators quite similar to those used for asthma. "Our other goal is to make sure the patients optimize their use of meds. Patients often don’t want to bother their doctors, so we give them better self-management skills."

When appropriate, oxygen therapy also can be appropriate. "Some patients need it continuously, while others only need it with exercise, or during sleep," she notes.

Another alarming fact of COPD is the comorbidities with which it is associated. "It’s not unusual for someone who is smoking to be a great candidate for coronary artery disease and COPD," says Kolock. "The coronary artery disease will probably show up earlier. Also, you’ll tend to see congestive heart failure because of the stress that’s put on the heart as well as the lungs."

For working people, COPD can be a particularly debilitating disease. "I think it bears saying from my perspective that while we deal with a lot of diseases, the exacerbations of many of them might not be as frequent as those for COPD," says Kolock. "COPD is something you live with almost constantly when its gets to severe levels."

The goal of the HMC program, of course, is to delay the progress of the disease to those levels. "We want to keep people at work longer, with a better quality of life," he concludes.

[For more information, contact:

Bob Kolock, MD, Medical Director, Health Management Corp., 6800 Paragon Place, Suite 500, Richmond, VA 23230. Telephone: (800) 523-9279. E-mail:]

COPD Facts

Chronic obstructive pulmonary disease (COPD) includes emphysema and chronic bronchitis, diseases that are characterized by obstruction to air flow.

  • COPD is the fourth-ranking cause of death just behind heart ailments, cancers, and stroke.
  • COPD claimed the lives of more than 112,584 Americans in 1998.
  • The annual cost to the nation for COPD is approximately $30.4 billion, including health care expenditures of $14.7 billion and indirect costs of $15.7 billion.
  • Smoking causes approximately 80%-90% of COPD cases. A smoker is 10 times more likely than a nonsmoker to die of COPD. Other known causes of COPD are frequent lung infections and exposure to certain industrial pollutants.

Source: American Lung Association Fact Sheet: Chronic Obstructive Pulmonary Disease (COPD), March 2002.