COPD’s Role in Respiratory Compromise

COPD is a tremendous healthcare burden in the U.S. and worldwide, and it is important for patients and their clinicians to understand COPD’s role in respiratory compromise.

To better understand some of the key issues every patient and clinician should know about COPD’s role in respiratory compromise, the Physician-Patient Alliance for Health & Safety is pleased to release a clinical education podcast with the Society of Hospital Medicine’s COPD Team.

Click to download SHM's COPD Guide
Click to download SHM’s COPD Guide

Experts from the Society of Hospital Medicine’s COPD team on the clinical education podcast were:

  • Dr Peter Lindenauer, MD, MSc, MHM, is Assistant Dean for Population Health, Director of the Institute for Healthcare Delivery and Population Science, and Professor of Medicine at the University of Massachusetts Medical School – Baystate, and Professor of Quantitative Health Sciences at the University of Massachusetts Medical School;
  • Dr. Valerie Press is Assistant Professor of Internal Medicine and Pediatrics at the University of Chicago;
  • Dr. Weijen Chang is a Med-Peds hospitalist, Chief of Pediatric Hospital Medicine and Associate Professor of Pediatrics at the University of Massachusetts Medical School-Baystate;
  • Dr. Joshua Labrin is Assistant Professor of Medicine at the University of Utah; and
  • Dr Richard Anthony Mularski is the Director of Northwest Permanente Research and Evaluation and a Senior Physician in Pulmonary/Critical Care Medicine at Kaiser Permanente Northwest in Portland, Oregon.

Dr. Lindenauer, who is the SHM’s COPD Team lead described the burden on our healthcare system from COPD:

“This is a condition that leads to more than 700,000 hospitalizations each year in the US, and has gone back and forth between being the third and the fourth leading cause of death in our country. 

 The costs for caring for patients with COPD has been estimated at 50 billion dollars or thereabouts. And, largely, that is due to the costs associated with exacerbations of COPD. So, the disease that I’ve talked about, a feature of it is flare ups or what we call exacerbations,  which leads to millions of visits to doctors’ offices each year, more than a million emergency room visits and, then for the very worst cases, there are hospitalizations.”

Key questions posed to the COPD panel, included:

Should There Be Screening to Identify COPD Patients?

Dr. Mularski commented on the controversial subject of screening for COPD, saying:

“Well, screening is a controversial subject among policy leaders and COPD experts. With the prevalence of diagnosed COPD in this nation of almost 14 million individuals and an estimated 12 to 16 million more remaining undiagnosed – that is based on epidemiological studies by NHANES – it certainly makes sense that efforts to identify COPD patients in the general population would be warranted.”

Do You Know How to Properly Use Your Respiratory Inhaler?

Dr. Press said that patients and their clinicians should ensure that any prescribed respiratory inhaler is used correctly:

“I think that if I had one shot at patients and providers, I would say at least know that inhaler technique is a problem. I’ve studied this and I know that patients aren’t always aware that they’re not using their inhalers correctly and providers across the board often don’t realize this, as well. We often, as physicians or nurse practitioners, write prescriptions and don’t realize that patients aren’t using their inhalers correctly and how tricky it can be to really get the medicine from the inhaler device into the lungs. 

 There are lots of different inhaler devices out there. They each have their own unique sets of steps and tricks to use them correctly.”

What Can Be Done to Prevent Readmissions for COPD?

Dr. Chang provided this advice to help prevent readmissions for COPD:

“the factors that we think about for readmission include core control for other comorbidities, worsening severity of the underlying COPD, poor adherence to their inhaled or non-inhaled medications, continued smoking, of course smoking cessation, poor nutrition especially in advanced COPD, and maybe most importantly underlying socio-economic issues.”

Should Antibiotics Be Used To Manage COPD?

Dr. Labrin discussed the use of antibiotics to manage COPD exacerbations:

“[antibiotics] are not recommended as preferred therapy for all patients, yet if I pick up a service and there are patients with COPD, more often than not they are on antibiotics. And, the reason for that is because there is some literature that suggests that there is improvement in treatment failure, mortality and other adverse outcomes when people are on antibiotics.

The Physician-Patient Alliance for Health & Safety encourages patients and clinicians to read the Society of Hospital Medicine’s COPD Guide, which is an excellent resource for clinicians to manage COPD in their patients.

The Physician-Patient Alliance for Health & Safety also encourage patients and clinicians to read the 2017 recommendations from the Global Initiative for Chronic Obstructive Lung Disease (or GOLD). The GOLD recommendations are the premiere evidence-based reference tool for the implementation of effective disease management plans, and represents the current best practices for the care of people living with COPD. The 2017 GOLD guidelines weigh in on numerous other aspects of the medical management of COPD.

To read a transcript of the podcast, please click here.

To listen to the podcast, please click here.


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