Recommendations

Strengthening National and European Efforts to Address COPD

Strengthening the capacity of national healthcare systems is crucial to effectively address the recurring gaps in Chronic Obstructive Pulmonary Disease (COPD) care. In order to do so, healthcare systems should enforce targeted prevention measures, improve coordination, and adopt a multidisciplinary approach to lung health.

At national level:

Establish national lung health plans: Develop comprehensive national lung health plans integrated in public health policies that encompass both early and accurate COPD diagnosis and optimal care management. These plans should prioritise prevention of COPD and should aim to enhance the overall quality of care.
Integrate COPD education across medical curricula: Promote training programmes on COPD for healthcare professionals, including for physicians, nurses, physiotherapists, and pharmacists. This training should emphasise early diagnosis, the administration of diagnostic procedures like spirometry testing, and effective management of COPD and its comorbidities.

At European level:

Promote COPD data collection and monitoring: Adopt systematic data collection and monitoring across Europe to better understand the impact of COPD on healthcare systems and its societal burden.

Strengthening National and European Approaches to COPD Care

Establishing lung health plans is essential to anchor COPD management within primary care settings, thereby reducing costs for both healthcare systems and patients.

At national level:

Break down silos for COPD multidisciplinary care: Multidisciplinary COPD care in the primary care level improves the early detection of COPD, slows down the disease progression, enables better management of comorbidities, thereby reducing associated direct costs.
Design strategies to reduce COPD indirect costs: Develop national strategies to tackle the indirect costs of COPD, such as sick leave, early retirement, and reduced productivity.
Pilot cost-effective prescription and reimbursement schemes: Introduce pilot schemes for the prescription and reimbursement of early COPD interventions and scale up their cost-effectiveness.
Optimise the distribution of healthcare force to meet the needs of COPD patients: Improve the organisation of healthcare workers to support COPD care by equipping primary care services with trained respiratory (community) nurses, and lung function testing devices to improve early detection.

At European level:

Prioritise lung health and COPD in EU financial instruments: Prioritise action on lung health and specifically on COPD through the EU4Health and Horizon programmes genuinely addressing chronic diseases.
Develop policies that support inclusion of COPD patients in the workforce: Develop and promote supportive policies that keep and integrate COPD patients in the workforce to promote active living, thereby reducing preventable absenteeism and indirect costs associated with the disease.
Develop comprehensive lung health training programmes for healthcare professionals: Earmark training programmes under the European Social Fund (ESF) aimed at incentivising healthcare professionals (including primary care providers, nurses, and physiotherapists) and medical specialists involved in chronic respiratory diseases to promote early diagnosis and optimal management of care for COPD.
Strengthen “Health at Work” Policies: Integrate lung health into policies addressing occupational exposure to chemicals, in order to prevent respiratory diseases and to reduce healthcare costs associated to decreased lung function due to occupational exposure.
Enhance technical support for COPD care through WHO/Europe: Guide WHO Europe Member States with roadmaps, technical support, and success indicators to strengthen healthcare systems’ capacity to monitor and deliver COPD care.

Investing in Lung Health through Public Health Initiatives

Since COPD is a preventable disease, investing in lung health requires public health policies and actions aimed at preventing risk factors exposure and improving health literacy. Both angles, legislation and education, are fundamental to decrease the prevalence of COPD and improve healthcare outcomes.

At national level:

Disseminate information on COPD risk prevention: Support the dissemination of information on the prevention of risk factors for COPD, through public health measures aimed at increasing health literacy.
Adopt and enforce public health laws to protect lung health: Implement and enforce public health legislation to protect lung health, including measures to reduce smoking and vaping, limit exposure to second-hand smoke for vulnerable groups and groups-at-risk, and offer free-of-charge support for smokers who wish to quit, including accessible smoking cessation programmes.
Reduce outdoor air pollution and provide public information: Implement ambitious measures to tackle outdoor air pollution and improve access to public information on air quality, with advice specifically addressed at vulnerable groups such as chronic respiratory disease patients, especially in areas impacted by exceeding air pollution levels, such as big size cities, industrial and mining areas and regions dependent on the burning of fossil and solid fuels.
Improve indoor air quality: Adopt a comprehensive framework to reduce indoor air pollution, including national and local schemes for health-based renovations (i.e., incentivising renovations in buildings where COPD patients live in), ventilation improvements and building maintenance.
Prioritise measures to reduce the impact of climate change related risks on COPD patients: Prioritise actions towards vulnerable populations, like people living with COPD and reduced lung function. Such actions should include early warning systems, healthcare systems and information plans to address risks such as wildfires and floods, expand green areas in urban environments to combat heatwaves, and reinforce civil protection mechanisms.

At European level:

Strive for a ‘Tobacco-Free Generation’ by 2040: Escalate efforts to achieve a tobacco-free generation before 2040 through additional restrictions on the commercialisation and use of smoking and vaping products, and by expanding the enforcement of smoke-free environments to all indoor and public spaces, and private spaces where children are exposed.
Align EU air quality legislation with WHO standards: Align European air quality legislation with WHO ambient air pollutant standards and ensure effective implementation at the national level.
Propose harmonised indoor air quality measures: Harness scientific evidence to propose basic harmonised measures to address indoor air quality standards and performance.
Act on the WHO/Europe Budapest Declaration Commitments on Environment and Health: Act on the commitment made in order to address the environmental and climate crisis that affect lung health.
Set minimum standards for civil protection services and promote research on the impact of climate hazards on lung health: Propose minimum standards for civil protection services and for information during climate emergencies that affect air quality. Promote research on the impact of climate hazards on lung health, particularly on people with chronic respiratory diseases.

Reducing COPD Progression through Early Detection and Awareness

Reducing the progression of COPD requires proactive measures, including early detection through lung health checks and targeted awareness actions.

At national level:

Raise awareness of COPD symptoms and risk factors: Conduct public awareness initiatives to promote COPD symptom recognition (i.e., dyspnoea, “shortness of breath”, chronic cough) while educating about risk-factors. These initiatives should be carried out in collaboration with civil society, particularly patients and healthcare professionals’ associations.
Strengthen primary care for COPD diagnosis: Ensure that COPD diagnosis is widely accessible by strengthening capacity of primary care as the frontline in managing COPD. This involves training and incentivising general practitioners to routinely perform spirometry testing and enhancing the role of nurses in running lung health check-ups.
Provide lung health checks for at-risk groups: Offer lung health checks for early detection of COPD in people who are symptomatic or at higher risk. Targeted groups include current and former smokers, patients with related comorbidities (i.e., asthma, Alpha-1, cardiovascular symptoms, osteoporosis) and those exposed to risk factors, such as chemicals, gas, fumes, and urban pollution.

At European level:

Earmark EU funding for COPD research: Allocate EU funds to support research on the lung function trajectories that may predict the development of chronic lung diseases, including the identification of new biomarkers for very early diagnosis, particularly among non-smoking patients.
Promote studies on the cost-effectiveness of early detection: Support health economic studies on the cost-effectiveness of early COPD detection across European regions and pilot screening programmes anchored in primary care.
Expand digital networks for early COPD detection: Invest in expanding and reinforcing digital networks to support early COPD detection. This includes harnessing the full potential of EU-wide registries, medical devices, machine learning technologies and the European Health Data Space.
Adopt a WHO Europe Lung Health Agenda: Advocate for the adoption of a comprehensive and multistakeholder WHO Europe Lung Health Agenda to improve COPD prevention and care across the region.

Guaranteeing Health Equity for COPD Care

To guarantee health equity for COPD, it is essential to scale up both the quality and availability of healthcare services, and to address the increasing shortages in the healthcare workforce.

At national level:

Close gaps in access to COPD care: Address disparities in COPD care whether they stem from rural-urban or disease-specific variations. Harmonise access to COPD care in countries where healthcare services are a regional competence.
Ensure access to timely COPD treatment: Guarantee that COPD patients receive the right treatment at the right time. Ensure affordable access to the full portfolio of COPD care interventions, such as:
1. therapies for COPD,
2. widespread availability of oxygen,
3. smoking cessation programmes,
4. immunization against respiratory viruses,
5. out-patient and community-based palliative care.
Set up national COPD programmes to improve standards of care:
1. Ensure adherence to clinical guidelines for COPD, including frequent monitoring, correct follow-up and patient centred approach based on health outcomes.
2. Establish a mandatory COPD management plan to be agreed between the patient and the physicians.
3. Centralise and ensure coherence in multidisciplinary COPD care, with specific focus on managing common comorbidities, such as other airways diseases, depression, obesity, cardiovascular disease, and osteoporosis.
4. Make pulmonary rehabilitation – both out-patient and virtual – integral to secondary prevention of COPD, ensuring that rehabilitation treatment programmes are systematically offered to all COPD patients following an exacerbation, regardless of their location.
5. Involve patient organisations in the development of national COPD programmes to ensure that patient needs and perspectives are represented effectively.

At European level:

Reinforce primary care for chronic conditions: Continue the investment in reinforcing primary care settings across EU Member States, with specific requirements for high-burden chronic conditions such as COPD and ensure effective integration of the primary care within the broader healthcare system.
Establish EU Centres of Excellence for chronic respiratory diseases: Support the creation of a network of EU Centres of Excellence for Chronic Respiratory Diseases to better connect medical specialities to achieve optimal care, upgrade standards and patient pathways, and catalyse breakthrough interventions, including pulmonary rehabilitation and telemonitoring.
Promote health literacy for chronic respiratory patients: Increase health literacy on the importance of accessing vaccination and immunisation against respiratory virus among people with chronic respiratory disease.
Set ambitious COPD care goals for the WHO Europe region: Establish ambitious pharmacological and non-pharmacological target goals for COPD care in the WHO Europe Region.

Creating a Supportive Environment for COPD Patients

A supportive environment is crucial to maximize the quality of life of people living with COPD and enhance their participation in decisions affecting their care.

At national level:

Promote co-decision in personalised care and self-management plans: Incentivise the co-decision of personalised and self-management plans that capture treatment, physical activity plans, and lifestyle options.
Adopt national social plans for employment and active living: Adopt national social plans that promote employment opportunities and active living options for people diagnosed with COPD, thereby enabling them to maintain a better quality of life.
Facilitate collaboration with patient organisations: Sustain a structured and permanent dialogue and collaboration with national and local patient organisations in order to assess limitations on COPD care and prevention and co-create solutions such as community-based pulmonary rehabilitation activities.
Invest in patient organisations to diversify care options: Provide unrestricted public funding and support to patient organisations at national and local level to diversify care options for patients. This could include coordinating with the healthcare system to provide patient education, counselling, and community-based services to COPD patients. Such measures will enable greater involvement of patients in their care.
Recognise informal caregivers for COPD patients: Include COPD in the list of conditions that enable informal caregivers to be recognised for their support. Recognise financial dependency allowance and family entitlements (e.g., carers leave), proportionate to the burden and needs of caregiving.

At European level:

Identify best-practices for active living with COPD: Identify and share European best practices for policies that support active living for COPD patients, such as reasonable accommodations at work, adaptable disability schemes, and employer incentives.
Support digital health education projects: Promote and support European-level digital health education projects aimed at lung health among the ageing population. Such projects should focus on basic pulmonary rehabilitation techniques, correct breathing, and lung function maintenance.

Developing patient-centred digital health strategies for COPD

To effectively support people living with COPD it is essential to enable and develop digital health and care strategies that prioritise patients’ needs and on usability.

At national level:

Provide digital health services to optimise COPD care: Offer access to digital health and care services that can optimise patients’ in-person COPD care and self-management, such as telemonitoring, connected medicines, testing devices, and digital diaries.
Involve COPD patients in the design of digital technologies for health: Offer access to digital technologies designed with and for the patients that are integrated in the healthcare system and provide training for healthcare professionals, patients, and caregivers on how to use the technology.
Enable virtual multidisciplinary teams and decisions for COPD. Facilitate virtual multidisciplinary teams and decision-making processes for COPD, allowing patients to easily connect their primary, secondary, and tertiary care providers for optimal care decisions.

At European level:

Support Real World Evidence studies on the onset of exacerbations: Invest in and support real-world evidence studies to better understand the onset of COPD exacerbations (at individual and populational level) to improve prevention, early intervention, and COPD management.
Adopt requirements for electronic product information to train on inhalation techniques: Establish requirements for electronic product information of combination products that include video options on how to use the device in order to improve inhalation techniques for COPD.
Develop a multi-platform device for inhalation training: Support the development of a multi-platform medical device to simplify training on optimal inhalation techniques for people with COPD, to ensure better use, concordance, and adherence of inhaled therapies.
Promote digital health literacy for COPD patients: Foster digital health literacy to increase patient access to digital tools to support COPD management, thereby empowering patients to be active participants in their health status and care.
Integrate European Centre for Disease Prevention and Control (ECDC) monitoring of respiratory viruses for COPD prevention: Incorporate the ECDC monitoring of respiratory viruses into COPD secondary prevention strategies to better protect patients.

Ensuring Continuum of Care for COPD During Health Crises

To enable the continuity of care for people with COPD during health crises, it is essential to address specific vulnerabilities and establish robust preparedness measures to safeguard lung health and prioritise people with existing chronic respiratory conditions.

At national level:

Assess and address vulnerability during health crises: Identify and address the vulnerabilities and degree of dependency of COPD patients during public health emergencies, ensuring they receive uninterrupted care and support, particularly when healthcare resources are strained, including medicines and workforce shortages.

At European level:

Strengthen EU preparedness for respiratory infections: Enhance EU level preparedness to deal with respiratory infections and with the usual virus season, ensuring that healthcare systems are equipped to support COPD patients effectively.
Address medicine shortages to ensure availability: Pay special attention to potential shortages of essential medicines for COPD ensuring timely measures to maintain their availability, especially during periods of increased healthcare demand.
Provide clear and science-based information on risks: Deliver clear, transparent, and science-based information on the risks of people with chronic respiratory conditions against a given pathogen, thereby enabling patients to make informed decisions regarding their health.

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The impact of COVID-19 on COPD Care

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