Please select the eligibility criteria that correspond to the clinical trial below.
Title: Opinion Leaders to Improve Care After COPD or Asthma Emergency Department (ED) Visits.
Brief Summary: This study will enroll patients who present to Emergency Departments (EDs) and have an acute exacerbation of Chronic Obstructive Pulmonary Disease (COPD) or asthma at discharged in one Edmonton ED. Patients will all be provided with evidence-based discharge (prednisone and an antibiotic for COPD and prednisone and inhaled corticosteroids for asthma) and will be randomized to receive enhanced education to the primary care provider or standard care. The investigators' goal is to determine if an opinion leaders' advice will improve chronic care in these patients.


Options:
A: Inclusion Criteria:

* 1. Provision of signed and dated informed consent form
* 2. Stated willingness to comply with all study procedures and availability for the duration of the study
* 3. Male or female, aged 45 - 80 years
* 4. Able to read and speak English or Spanish

Exclusion Criteria:

* 1. Previous clinician provided diagnosis of COPD
* 2. Treated respiratory infection (with antibiotics and/or systemic steroids) in the past 30 days
* 3. Participants unable to perform spirometry due to any of the following conditions within the past 30 days

  1. Chest surgery
  2. Abdominal surgery
  3. Eye surgery
  4. Heart attack
  5. Stroke
B: Inclusion Criteria:

* Appropriately signed and dated informed consent has been obtained;
* ED patients presenting with an acute exacerbation of COPD requiring treatment in the ED;
* Previous physician-diagnosis of COPD (e.g., emphysema, chronic bronchitis or COPD) either previously or within the ED;
* Age \> 40 years of age;
* Current or former smokers of more than 10 pack years (number of packs of cigarettes {or pipe and/or cigars) smoked per day X the number of years of smoking);
* FEV1/FVC ratio \< 0.7 for age, sex and height (either known or determined within the ED);
* Patients can read and comprehend English language.

Exclusion Criteria:

* Patients presenting for prescription renewal;
* Patients who require hospitalization;
* Patients who do not have a primary care physician or patients for whom a family physician cannot be found;
* Patients who have already been enrolled in the study;
* Patients with a ED physician-diagnosis of primary asthma, pneumonia, HIV/AIDS, immuno-compromise, or life expectance of \< 90 days;
* Patients who, in the opinion of the investigator, should be excluded.
C: Inclusion Criteria:

* Age \>40 years
* Chart-document severe or very severe COPD (FEV1\<50% predicted) or COPD-related ED/hospitalization ≥ 1 visit within the past 12 months
* Prescribed any daily medication for COPD, English or Spanish speaking, Smoking history ≥ 10 pack-years

Exclusion Criteria:

* Diagnosis in the clinical record of dementia, because the study focuses on patients with capacity to independently perform self-management tasks.
D: Inclusion Criteria:

* COPD defined as chronic irreversible airflow limitation with FEV1 \< lower limit of normal for age as % predicted and a FEV1/FVC ratio \< than lower limit of normal (usually 70%) \[5\]

Plus ≥ 2 comorbidities commonly associated with COPD as identified in the Canadian Thoracic Society COPD guidelines\*

1. Cardiovascular disease
2. Osteopenia and osteoporosis
3. Glaucoma and cataracts
4. Cachexia and malnutrition
5. Peripheral muscle dysfunction
6. Lung cancer
7. Metabolic syndrome (diabetes mellitus)
8. Depression
9. Chronic kidney disease OR Other conditions as primary admitting/presenting diagnosis + COPD as significant comorbidity + ≥ 1 other comorbidity

THAT

1. Get admitted to participating hospital; or
2. Present to participating hospital ED; or
3. Have first referral to Respiratory Centre/Respirology team

AND HAVE

1. ≥ 1 ED presentation/hospital admission in previous 12 months
2. ≥ 50 years age

Exclusion Criteria:

1. No access to primary care physician
2. Primary diagnosis of asthma
3. Terminal diagnosis (metastatic disease with a life expectancy of ≤ 6 months)
4. Dementia and absence of family caregiver able to assist with activation of the action plan and feedback on ongoing status and care coordination
5. Uncontrolled psychiatric illness
6. Inability to understand, read, and write English
7. No access to a phone
8. Inability to attend follow up at one of the participating sites

Answer: B