Approaches to chronic disease management for asthma and chronic obstructive pulmonary disease: strategies through the continuum of care.

Investigator-initiated research in both asthma and chronic obstructive pulmonary disease conducted at the Baylor Martha Foster Lung Care Center has sought to improve management throughout the continuum of respiratory care using a multidisciplinary approach. Respiratory care therapists employed in the primary care setting were shown to improve the quality of asthma care: rescue inhaler use decreased by 75% and respiratory symptom score decreased by 49% in patients who were seen by this midlevel specialty provider. In addition to similar results in a geriatric population, patients' diagnosis was changed in 48% of cases and treatment was changed in 76% of cases after the intervention. For pulmonary rehabilitation, an activity of daily living assessment form was created, and rehabilitation-whether traditional or water-based-was shown to improve patients' ability to perform activities of daily living and improve quality of life scores. The Rules of Two((R)), developed by Baylor University Medical Center at Dallas to simplify understanding of good asthma control, continues to be taught, and patient education has also been offered through asthma summer camps for children. Finally, a multidisciplinary team worked to develop a protocol for treatment of asthma patients in the emergency department and, through this effort, was able to reduce length of stay from an average of 278 minutes to an average of 168 minutes. These efforts aim to overcome the gap between recommended care and actual practice, so that patients benefit from evidence-based medicine and continuing refinements to diagnosis and treatment.