Respiratory disease management - Yesterday's failures, tomorrow's successes

Although chronic obstructive pulmonary disease (COPD) is an increasingly im portant cause of morbidity and mortality in the US, it has been neglected b y both the provider and disease management communities partly because of th e difficulty in demonstrating financial returns on investment and an absenc e of evidence-based guidelines and economic evaluations of alternative ther apeutic approaches. It is. however, a clinical entity that is amenable to s tructured disease management with achievable and measurable clinical, finan cial and health-related quality-of-life outcomes. Program design considerat ions, population identification and behavior modification approaches are di scussed. With limited objective clinical improvement potential in COPD, ris k stratification and outcome measurement based on symptom improvement are p roposed.