Citation8 The change from conventional treatment and symptom management to a more systematic primary care approach with potential reduction of hospitalization and mortality is supported in the literature. Citation9– Citation11 GPs are responsible for patient motivation and follow-up, evaluation of goal fulfillment, and for adjusting or terminating the effort. Citation5, Citation8 Moreover, it is recommended that the GPs monitor patients with COPD routinely, at least once a year. Danish GPs are able to offer pharmacological treatment and refer the patients to pulmonary rehabilitation (PR). The treatment of COPD is mainly managed by general practitioners (GPs), Citation6, Citation7 who play an important role as frontline care workers. Medications are usually paid for by the patients. Citation5 In Denmark, most health care services are financed through income tax. After the publication of the first Global initiative for Chronic Obstructive Lung Disease document in 2001, COPD gradually became a focus area for the Danish Health Authorities, and several national treatment guidelines have been published in recent years. In 1998, the Danish Lung Association introduced the first national guidelines on management of COPD. Before 1990, many patients in the general practice were often not diagnosed with COPD but were treated based on their symptoms without the use of spirometry. Citation4 In Denmark, there has been a substantial improvement in quality of COPD management in the last 25 years. One of the main pillars of COPD management is effective pharmacological treatment, providing symptom relief, and reducing the rate of exacerbations and hospitalizations. Other benefits of rehabilitation programs are related to relieving anxiety and depression associated with COPD. Moreover, rehabilitation programs 4) promote a more speedy recovery from hospitalization in case of exacerbation and 5) reduces the frequency of hospitalizations and days in hospital in the event of an exacerbation. Citation1, Citation3 Rehabilitation programs, with physical activity, patient education, and smoking cessation as treatment elements, have proven to be important for 1) reducing breathlessness, 2) improving exercise capacity, and 3) health-related quality of life. Citation1, Citation2 Smoking cessation can delay further disease, and both medical treatment and physical activity can reduce symptoms. The incidence has increased over the years, and COPD is today the fourth highest cause of death in the world. COPD is an incurable disease representing a major health problem.
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