Desktop Helper 3 - Supplementary Information 2 - Sri Lankan approach described by Seneth Samaranayake

S2 Sri Lankan approach described by Seneth Samaranayake

1. Though the majority of people with COPD are male smokers we see an increasing number of women at our clinics now. It is thought to be mainly due to many other causes of COPD: garment factory workers and women working in other manufacturing institutions where there is textile dust, tea dust, paper dust and biogases.
2. COPD is commonly managed in general practices and specialized pulmonary clinics in Sri Lanka. Usually, people with COPD are referred to secondary care units when they need oxygen for longer periods during exacerbations. However, when they are successfully managed they come back to general practices for long term follow up.  Therefore, a palliative care approach needs to be started at general practices and it is practised up to different levels depending on the interest of the GP and available time at these clinics.
3. At my general practice in a suburban area in the southern part of Kalutara we start palliative care at the time of COPD diagnosis. After a careful history I identify the needy areas in palliative care and document them. Highly individualized care by our health team offering empathy and interest in educating them creates an excellent rapport which will help in all aspects of palliative care later on when the disease progresses.
4. Integrating palliative care approach starts at the time of diagnosing COPD. Taking a detailed history including a social history by the GP identifies the person’s needs and concerns. As these needs and concerns keep changing, we always try to serve the person with a particular trained nurse who will be their contact throughout their illness. They will keep their record and all their symptoms and signs, development, concerns and the way they change are documented at every visit and recorded. The nurse will be the person’s 24 hour contact over telephone for problems and queries.  She needs to have the facility for video and audio calls as well. Whenever the person with COPD comes to the clinic all these health parameters and other concerns are observed and recorded at the pre-consultation room. The pre-consultation room is the health care point before the person enters the consultation room where basic health information is gathered, and measuring disease control parameters are measured and recorded.
5. Their need for social, psychological and spiritual support can be easily identified and resolved by timely action by the GP in consultation with the trained nurse allocated for the person with COPD. Many times the rapport between the two of othem helps the person to get advice, and encouragement for legal, social and spiritual care making their quality of life better. Even in the clinic, people with 3rd and 4th stage COPD can have preferences in care by having careful heath monitoring with a separate numbering system for consultation. Contacting the local religious leaders according to the person’s preference and organizing their involvement with religious activities makes the quality of COPD care unique. This can be done by the GP easily.
6. Pulmonary rehabilitation in COPD too is arranged at the pre-consultation room and appointments are given. Physical components of rehabilitation varies from brisk treadmill tests in stage 1 and 2 COPD patients to very limited limb raising exercises in stages 3 and 4. However, for all people with COPD, unless there is central functions degeneration, pranayama (yoga breathing techniques ) can be taught. These breathing techniques are very useful as components of pulmonary rehabilitation.
7. Oxygen use in COPD can be offered to people with low oxygen saturations after recognizing carbon dioxide driven systems clinically. Morphine in our country is exclusively dispensed from state owned pharmacies and only on prescriptions for shorter periods. However,  use of morphine in COPD occurs only during the later stages of palliative care approach in end of life care.