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Community-Acquired Pneumonia (CAP) Treatment: The Airway Programme

The Airway Programme treats patients with respiratory conditions such as community-acquired pneumonia.

Community-acquired pneumonia (CAP) and chronic obstructive airway disease (COPD) are major problems globally. In Singapore, they constitute about 20 percent of all deaths and are major causes of hospital admissions. As both conditions use the same resources and expertise, the combined programme, called The Airway Programme (TAP), maximises resources and expertise to achieve better patient outcomes.

Under TAP, all patients diagnosed with CAP and/or COPD at the National University Hospital (NUH) Emergency Medicine Department will be evaluated for clinical severity and the need for hospitalisation.

CAP Treatment in Singapore

Low-risk CAP patients who are identified for home care will be treated with antibiotics and given an outpatient appointment in two weeks. Where appropriate, the team will follow up with a call and home visit. If the patient’s condition does not improve or symptoms persist, he or she will be transferred back to the hospital. High-risk patients will be admitted into the hospital for treatment.

COPD Treatment in Singapore

Patients with COPD will be similarly be assessed. Low-risk patients will be evaluated for home care while high-risk patients will be hospitalised. In addition, a comprehensive and individualised patient education programme will be provided to patients to improve their quality of life, and prevent exacerbations and hospital readmissions. They will also be taught daily preventive treatments and self-management, including the use of a COPD action plan.

Smoking cessation, pulmonary rehabilitation and vaccination will also be performed for patients in TAP.

Objectives of The Airway Programme

• Prevent worsening of the disease

• Relieve symptoms such as breathlessness and cough

• Improve ability to perform daily tasks and exercises

• Improve health status and longevity

• Prevent and treat complications resulting from the illness

• Prevent and treat periods of worsening of the condition

• Help patients quit smoking

Quitting smoking will make a huge difference to the progression rate of respiratory diseases. While the damage that was already done to the airways cannot be reversed, stopping the habit helps to prevent further deterioration of the condition. It is never too late to stop smoking at any stage.

TAP Programme Outline

• Perform physical examination, assess signs and symptoms of disease progression and check on patient’s home situation and safety.

• Educate patients and caregivers on COPD disease process, coping strategies, action plan, home exercises and self-management.

• Ensure patients and caregivers are able to comprehend the medication regimes and techniques. Provide education on the care of equipment and safety measures of home oxygen, nebuliser and home ventilation.

• Provide smoking cessation counselling.

Benefits and Advantages of TAP

• Enrolled patients can call the case manager when they have any enquiries; to request for prescription or a change of appointment date; or need advice pertaining to the illness.

• 3+1 bonus card will be given to patients for medication purchases.

• Case managers will also call patients:

o To remind them of their respiratory follow-up appointment.

o If they do not turn up for their appointment.

o During crisis conditions (e.g. influenza epidemic, haze) to give advice on coping strategies and action plan.

• Keep track of patient's vaccination dates and ensure all enrolled patients are vaccinated according to their schedule date.

• Plan, co-ordinate and monitor patients care planning in collaboration with doctors and other healthcare members to ensure that cost-effective care is being delivered to the patient.

• Refer patients to respective departments such as Medical Social Work, Home or Inpatient Palliative Care, Pulmonary Rehabilitation Programme, according to their needs.