COPD Awareness Month: Reflecting on Our Patients
By: Megan Conroy, MD, and Navitha Ramesh, MD
November 16, 2018
November is COPD awareness month, and while CHEST members don’t need to be reminded of the prevalence and global public health importance of one of the world’s most common pulmonary diseases—we are reminded this month of our patients’ journey through living with COPD and reflecting on our care of our patients. Often, improving the lives of our patients with COPD requires a recognition of co-morbid disease and a multidisciplinary approach to care inclusive of preventive care; pulmonary rehabilitation; attention to mood disorders; nutrition; and, at times, consideration of advanced treatments.
We would like to share about a few of our patients who are making the most of their lives while living with COPD.
Mr. R quit smoking many years before his COPD diagnosis was made. Unfortunately, he first presented to care because he had been diagnosed with laryngeal cancer and struggled significantly with control of his COPD after laryngectomy—and he was no longer able to take his typical inhaler therapies. He came to me 2 years later still being prescribed the same ineffective delivery methods for his inhaled therapies. Already limited in his communication, we have found his care is optimized not only by a nebulized delivery method but also by frequently utilizing the written messaging system in the electronic health record. Personalizing COPD care with a consideration of unique circumstances and co-morbidities is often the key to optimizing control and quality of life.
Mr. M has smoked for most of his life and has carried a diagnosis of COPD for 10 years. He struggles with breathlessness in his activities of daily living but continues to be the primary caretaker for his elderly mother. Having struggled to keep on weight and experiencing frequent COPD exacerbations, his burden of disease is significant. Triple inhaler therapy is only the beginning of the meaningful interventions Mr. R looks to me as his pulmonologist, but he and I have struggled to optimize his quality of life. After recognizing the burden of major depressive disorder, we are working to improve his mental health while empowering him and his muscle groups through pulmonary rehabilitation and hoping that he can find the added benefit of a supportive community through rehab.
Ms. L is an 84-year-old woman with a 50-pack year smoking history, quitting smoking about 5 years ago. She regularly sees me at the pulmonary clinic every 3 months in order to make sure she’s getting all her refills. She recently lost her husband to a heart attack and had been feeling depressed lately. She was trying to find something to help her keep them occupied. She had asked me for my recommendations as to how she could improve her mood as well as her exercise capacity. I suggested that she enroll in pulmonary rehabilitation. She completed her 6 weeks of pulmonary rehabilitation and she truly enjoyed it. She is continuing the maintenance phase at a local Silver Sneakers program. She is still living with her FEV1 of 0.91 L; however, she is full of life!
Mr. T has alpha-1-antitripsin deficiency. He is a lifetime nonsmoker. Having lived with this disease for 36 years, he decided to enroll in lung transplant and eventually underwent a lung transplant at the age of 42 years. Despite having suffered early on with this disease, he is now living his life to the fullest. He is married and recently went on a hiking trip.
As described, COPD has different faces. Not every patient is the same and not everyone’s treatment is the same. Personalizing treatment to improve patient quality of life and preventing disease progression should be our goal in managing this chronic disease.
Megan Conroy, MD, is a second-year fellow in pulmonary and critical care medicine at The Ohio State University. Her clinical interests lie in critical care and asthma, and she is a candidate for a Master’s of Medical Education. Her research interests are in better understanding the factors influencing entrustment decision-making among physicians supervising trainees. She is the fellow-in-training member of the CHEST Airways Disorders NetWork Steering committee and a member of the CHEST Trainee Work Group.
Navitha Ramesh, MD, is a Clinical Assistant Professor of Medicine at Geisinger Commonwealth School of Medicine and an associate in the Department of Pulmonary and Critical Care Medicine at Geisinger Medical Center in Pennsylvania. Dr. Ramesh is a steering committee member of the CHEST Airways Disorders NetWork. Her clinical and research interests are personalizing COPD management, severe asthma workup and management, and critical care ultrasound.