Ambulatory care for emphysema and chronic bronchitis.

e immense problem of chronic ainvay oh.I\IBCLITORY CARE ~ O C R I S I T:truction ( CAO )-emphysema and chronic Poiir,,i rducai ion bronchitis-which has reached pr* The management of .I") chronic dkease nus st be based portions, presents to the practitioner of medicine an ttpon a high le\el of patient indoctrination and educahan. increasing number of suffering nersons asking for Thts has heen the rrson for sums ~n large meutlres ~n u A " care. These patients are dyspneic, ansious, bewildered by their predicament, sometimes demanding and frightened about prospects for future comfortable life. Although there has been a tremendous upsurge of interest in the field of respirator). care, and a growing number of nehulizers. humidifiers, ph)sical therapy techniques and drugs. all of the answers on emphysema care are not in. \Ye must admit as physicians that although \ve are absolutely sure that we save many lives in the organized intensive respiratory care unit in the case of acute respirator). failure,' 2 no study has thus far mn\.inced the critics of respiratory care that the natural course of C.AO is altered from the standpoint of sur\ival. Sonetheless, today's patients cannot wait for all the answers. They flock to hospitals. clinics and physicians' offices. seeking some relief of their symptoms, some diaheks mellitus management where far yean, the sufferer has I m n lmtnacted ~n nutrihon, actlvih., imtllin dosage, selfmanagement, ebalnahon of glycoruria and proper clothing, lending to the dexelopment of an adlustment to the hurdenc of dlsence designpd for a ma*~mum of serenity in daily life. It does not take a great deal of talent, although ~t doer take time, to describe the airways. the lungs, the circulatinn and to e tp la~n what IS wrong ~n the emphysema-chronic bronchihs spectntm. The office nurse or clinic nnne, once properly trained herself, a a superb ~ndwidual to assume the respons ~ b ~ l i h of this task. Patients receive an indepth discussion of general care with reinforcement in spclfic instructions guided by the phys~cian's explicit prescription. These sessions are supplernmtrd by a simple treatment manualWdnigned to g n e the pdt i~nt amatcrlal for smou, readlng which will reinforce the praonal inbtmruction and probably develop new rluestiom for the nurses on revir~ts. \Ve not only teach the patienh about their dlrease process, but what physicians, nurses and thernptsts are b i n g to do tn their therapeutic endeavon. \Ve stress the specific facets tn management l~sted b l o w with details stressed for each ~ndlvidual pahmt.