Posted on February 25, 2020 |
Read and comment on our latest PRAXIS case study!
Current Visit: Paul S. is a 60-year-old man with a diagnosis of COPD. He is being seen by his pulmonologist as a sick-visit due to a “cold” he has been unable to recover from for two weeks. Symptoms from this illness have become progressively worse, with increased green sputum production, and increased breathlessness at the time of this visit. Paul has had to take off work for the past three days due to impact of these symptoms and is worried about how much longer it will take him to feel well enough to return to work. This is a big concern for him because he is self-employed as a stone mason and no work means no income.
This post was written by Dr. Stephanie LaBedz, pulmonologist and post-doctoral research fellow, and Ellen Stein, senior research specialist. Both authors represented the Breathe Chicago Center at the University of Illinois at Chicago at the November 13th meeting, “COPD National Action Plan: Tracking Our Progress,” hosted by the National Heart, Lung, and Blood Institute.
Perspectives from Stephanie LaBedz, MD
As a pulmonologist who cares for patients with COPD, I am all too familiar with the many challenges faced by patients with COPD, their caregivers, and the healthcare providers who strive to improve the lives of these patients...
Guest blog by Mike Hess, RRT, RPFT
One of my all-time favorite TV shows is Battlestar Galactica. While I grew up with the campy, cheesy original with Lorne Greene shepherding the “rag-tag fugitive fleet” to a new home among the stars, I actually prefer the more recent 2005 reboot. This version took a much more grounded, realistic approach to storytelling and moral discussion. One of the recurring motifs of the show is the phrase, “This has all happened before, and it will happen again,” and ideas like resurrection, learning from history, and breaking cycles.
Unfortunately, this motif seems to have become all too real for anyone involved in the lung health community. I was recently at a meeting of one of our local Better Breathers groups to discuss the upcoming launch of a new Harmonicas for Health program, and the group facilitator had brought some prints of old cigarette ads. The messages on these ads ranged from the clinical (“20,679 Physicians Say “Luckies are less irritating!”) to the risqué (“Blow in her face, and she’ll follow you anywhere”), but a common theme is that certain cigarettes are awesome. They’re what the cool kids like Lucille Ball and Bob Hope are doing, and some of them can actually even be good for you. After all, if the typical smoker inhales 200 times per day, that’s “200 good reasons you’re better off smoking Philip Morris,” right? They’re proven mild! (**NOTE: Most of these ads are available at https://gizmodo.com/14-absurd-ads-from-before-we-knew-cigarettes-could-kill-1499396560 for citation and/or pictures, Hope/Ball ads are at http://exhibits.library.yale.edu/exhibits/show/sellingsmoke/celebrities**)
We know better these days, of course. We know that no cigarettes are healthy, no cigarettes work to improve asthma, bronchospasm, or anything else, and it wasn’t cigarettes that won World War II. We know that these statements are absurd and ridiculous. But we also know we’re seeing the same kinds of imagery and arguments being used right now to support electronic nicotine delivery systems, or ENDS. These devices, more commonly known as vapes or e-cigarettes, are becoming nearly ubiquitous in modern society, much like smoking once was. And, again as in the case of their combustible ancestors, these devices are being sold as an indispensable accessory for an aspirational lifestyle.
Imagine if you will, you’re seeing one of your folks with COPD. Inpatient, outpatient, doesn’t really matter. You’ve seen Mr. or Mrs. X more often than you should have over the past few months. No matter what you do, they keep coming back to your office (or worse, heading to the emergency department) with uncontrollable shortness of breath. You ask them if they’re using their inhaled medications and they tell you, “Yes, of course.” You’ve heard that before, but a quick check of the counter seems in line with at least most of the expected doses. You’ve run through pretty much the whole gamut of meds in the desired class, so now what? There’s nothing left, right? Maybe this is just where they’re going to live from now on.
Or maybe not. Although many people have an idea of inhalers being easy-to-use medication delivery systems because that’s usually what they see on TV, anyone who has ever had to use one (or teach one) knows that’s simply not true. Inhaler technique is a learned skill, no different from driving a car or riding a bicycle (or typing a blog entry). Like many other skills, use of an inhaler is not necessarily mastered quickly or without practice; however, if we truly hope to be effective in helping our patients live their best lives, we must start taking more time to evaluate their technique and guide them toward mastery.
Therein lie a couple of problems. First, we don’t always know what the best technique is. As a respiratory therapist, I’m quite sure I was taught all the steps of proper metered-dose inhaler priming and activation, but I’m also quite sure my polished technique fresh out of RT school eventually got dusty and rusty from disuse. It wasn’t until I started doing outpatient disease management and teaching technique regularly that I discovered I had been teaching the wrong things for who knows how long. I’m not alone, either; a 2014 study of inpatient nurses found that while 71% of those surveyed felt confident in their MDI skill, 79% were observed to have critical errors in their technique.(1) A more recent study published in Respiratory Care even found that fewer than half of pulmonologists surveyed felt confident in their knowledge of inhaler technique.(2) If we can’t teach, how can we expect our patients to learn?
Community-acquired pneumonia (CAP), which carries a high morbidity and economic burden worldwide, can be even more physically and economically devastating to individuals with COPD, according to a new study posted online in Chronic Obstructive Pulmonary Diseases: Journal of the COPD Foundation. The study was conducted by the COPD Foundation in collaboration with and funded by Pfizer Inc.
“Patient-Reported Consequences of Community-Acquired Pneumonia in Patients with Chronic Obstructive Pulmonary Disease,” one of the first studies to include only COPD participants and individuals younger than 60, concluded that individuals with COPD suffering from CAP will miss an average of 21 days from work, be impaired from normal activities for more than 30 days and experience weeks of lingering symptoms.
Nearly 500 individuals with COPD who had also recently received a CAP diagnosis completed one survey within 120 days of their initial CAP diagnosis and a second survey 30 days later via the secure online, interactive patient registry—the COPD Patient-Powered Research Network (COPD PPRN). Participants were recruited via multiple routes including posts on the COPD Foundation’s COPD360Social online network, Facebook posts and outreach to existing research participants in the COPD PPRN.
Participants’ CAP diagnoses were self-reported without medical record verification, however 96.5% of participants stated they did have a chest radiograph or computerized tomography to diagnose or confirm their CAP.
By Jane Martin, BA, LRT, CRT, Assistant Director of Education at the COPD Foundation
As a healthcare provider for individuals with COPD, you are well aware that many of these individuals have similar experiences related to their disease. The ways patients work with their healthcare providers and what they expect from them can vary greatly. This blog post will touch upon some things that individuals with COPD look for in working with their prescribing healthcare providers, including physicians, physician assistants and nurse practitioners.
A diagnosis of COPD carries with it a unique set of emotions, attitudes and outlooks. Living day-to-day with COPD can cause individuals to feel vulnerable yet sometimes come across as skeptical or even negative. Patients with COPD need healthcare professionals who understand this. In their own words, here are some things to keep in mind:
- It’s important that you really listen to what I’m trying to say.
- Know that I am experiencing loss of physical and social activities – of my former life.
- Know that I may have gone through a long, painful journey of denial to come to this point.
- If my COPD was caused by cigarette smoking, please don’t shame and blame me. At this point, I get it and I need your help.
- I am more than this disease. In spite of COPD, I am still me. I have a life, people I love and who love me, the same as you.
- I have meaningful goals for my life. I may not know where to start in setting goals or if there’s even time left for me to consider them.
- As a person with COPD, I may have to work at having self-confidence and speaking up, especially in interactions with my healthcare providers.
This post was authored by Danny Pham, PharmD, BCPS, BCACP, BCGP, Inpatient Care Transitions Pharmacist at Baylor Scott & White Medical Center – Plano. Read more about their successful COPD readmissions reduction efforts in this latest PRAXIS Nexus blog post.
Before we started our COPD program at Baylor Scott & White Medical Center – Plano, our readmission rate was similar to other institutions across the country. We knew there was more we could do to help our patients better understand their condition, be more engaged with controlling their respiratory symptoms, and take a proactive role in slowing the progression of their disease ...
For individuals with COPD, there is a lot of medical information to take in. Once they have that information, there is also lots to keep track of – medications, specific nutritional needs, safe exercise methods, level of activity, oxygen use if needed and more. As if this were not overwhelming enough, they must then sort through this information, process it and ask the right questions – vital questions in order to know what they need to manage their COPD and stay well.
You may have heard the old saying “Two heads are better than one.” This really does hold true, especially when it comes to optimizing health. And this is why it can help to have a “health buddy.”
Patients and patient-led organizations are becoming more active participants in discussions about how to address health challenges on a global level. By Bret Denning, JD, COPD Foundation Care Delivery and Communications Program Specialist
Pfizer hosted a luncheon briefing, Global Trends in Health Care, with an emphasis on the role patients and patient-led organizations can play in influencing policy. Moderated by Angela Wasussa, Vice President of Global Policy at Pfizer, the panel featured renowned experts from around the world.
By Bret Denning, COPD Foundation Care Delivery and Communications Program Specialist
Several COPD Foundation staff members attended a workshop on how the COPD National Action Plan can be used to advocate for better treatment options in rural America. Here is one analysis of the workshop and the common themes that emerged from the day.
I attended a workshop at the National Heart, Blood and Lung Institute (NHLBI), COPD & Rural Health: A Dialogue on the National Action Plan. It was a fascinating conversation on how the different components of the COPD National Action Plan can be transformed from theory into actual practice in rural America.
The workshop began with some sobering facts about COPD in rural America and the unique challenges facing residents of those areas. According to the Centers for Disease Control, COPD rates are significantly higher in rural areas (8.2%) than in urban settings (4.7%). For the most part, residents of rural communities tend to be less educated and more likely to smoke, two traits commonly associated with higher levels of COPD. Access to care is a constant challenge for rural communities and this makes it harder for individuals to be diagnosed with COPD and, perhaps more importantly, to receive the treatment they need to manage their condition.
The program featured a discussion of each component of the COPD National Action Plan with presentation by leading experts in the field. What made this workshop so unique and impactful was the interactive nature of the program. The presentations were meant to facilitate discussion among attendees so they could share experiences and examples of what they are doing in their own communities.
Read our next PRAXIS Nexus case study! Today, we will learn more about Meg S., age 62.
Meg S. was referred to pulmonary rehabilitation following a visit with her primary care provider. Here is some of the information shared in the pulmonary rehab intake interview.
Past utilization: Meg has been seen in the ER x 3 over the last three months for extreme shortness of breath, rib pain and intractable cough, feeling as if she’s “choking on my phlegm.” On the second visit, she refused an overnight admission to acute care due to obligations at home. One week later, on her third visit, in addition to nebulizer treatments, low flow O2, and smoking cessation counseling, she was provided with an Acapella device for secretion mobilization.
The COPD Foundation's Jane Martin had the honor of attending the first Rude2Respect Summit in Evanston, Illinois. The summit was a gathering of individuals representing more than 40 chronic health conditions or disabilities – disorders often confronted with the burden of health-related stigma. Read about her experience attending and reflecting on this important event.
Meet Susan M! Share your impressions in our latest COPD case study.
Summary of in-patient admission: Susan M. is being discharged today following a 6-day ICU and step-down admission for acute exacerbation of COPD with bacterial pneumonia requiring intubation and mechanical ventilation for a period of 32 hours. Subsequent to her extubation and transfer to the step down unit she was treated with oral antibiotics and Albuterol and Ipratropium nebulizer q 4 hrs. and prn at noc.
At an annual conference of the American Association for Cardiovascular and Pulmonary Rehabilitation (AACVPR) in Charleston, South Carolina, the COPD Foundation's Jane Martin, BA, LRT, CRT met Robyn West, a representative of the Breathe at Ease program. She was impressed not only with the Breathe at Ease program outcomes but with Robyn’s enthusiasm. Over the following weeks Robyn and her colleagues talked with members of the COPD Foundation's Care Delivery Team about this exciting new COPD management program. Here is a summary of that conversation.
We're interested in your thoughts on another COPD case study: Jim B., a 68-year-old man here for his Phase II Pulmonary Rehabilitation intake interview.
A bit more about Jim:
Medical history: COPD, FEV1 six weeks ago was 38% of normal predicted, recent CXR shows flattened diaphragm with increased AP diameter, appendectomy age 34, broken nose and broken right arm as a child.