I remember the first patient I treated with severe Chronic Obstructive Pulmonary Disease, or COPD – an umbrella term for a variety of progressive lung diseases, including emphysema, bronchitis and refractory (non-reversible) asthma.
The day I met him, he was so breathless from the short walk between the waiting room and the exam room that he could barely speak two words between breaths. I assumed he was there to see me for his breathing, but he actually felt his breathing was normal – he was in the clinic for an ingrown toenail.
It was a dramatic lesson for me. People can get used to their breathing symptoms to the point that they don’t notice them.
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COPD is the third leading cause of death in the US – more than breast cancer and diabetes combined – claiming one life every four minutes and afflicting nearly 27 million Americans. That is why education is so vital, and why November has been declared COPD Awareness Month. But patients need more than awareness – they need action.
COPD is especially serious because it is often undiagnosed. By some estimates, more than 80% of patients have “moderate” or “severe” COPD by the time they are diagnosed officially, meaning they’ve already lost substantial lung function. Because of this pattern of late diagnosis, patients miss the opportunity to receive important preventive and symptom treatment earlier in their disease. By the time they see a doctor, many are already at risk for requiring hospitalization. This has serious implications for patients – and for the healthcare system as a whole.
What needs to be done to get COPD patients more timely treatment and ultimately to bend the curve on this insidious disease? As a pulmonologist focused on COPD, I can say with certainty that improved physician-patient communication – based on a model of care that puts the patient’s needs and particular circumstances front and center – is the key.
First, many COPD patients need help in better understanding, and sharing, their symptoms. Remember my patient with the ingrown toenail? He wasn’t there to ask me about his breathing. Like so many COPD sufferers, he was minimizing his symptoms. In fact, in a recent survey funded by GSK, 70 percent of patients rated their COPD as “mild” or “moderate” – but when pressed, more than half reported “a significant shortness of breath.”
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Further, many COPD patients, when first experiencing breathlessness, focus on alleviating the immediate trigger – cutting back on physical activity, for example – rather than addressing the underlying cause.
There are a range of treatments available for COPD, and the sooner we can partner with our patients, the sooner we can try to alleviate their symptoms and improve their quality of life.
Physicians play a vital role in helping patients to identify changes in their symptoms and lifestyle, so that they can get an accurate diagnosis and treatment that can help. Rather than asking “How is your breathing?” physicians need to probe further and help patients talk about what kinds of limitations they are experiencing in routine activities, and what they have cut back on or stopped doing altogether, in order to avoid the discomfort of breathlessness. Family members and friends, too, can help by asking these questions, and encouraging patients to talk with their doctors about these changes.
Ultimately, enabling a constructive patient/physician dialogue means that physicians need to invite patients to become equal partners in their own care, and to give voice to every patient’s uniqueness. This includes helping patients understand sometimes-complex medical terminology – and even the term COPD itself, which can cause confusion. (Some patients may associate the term emphysema or bronchitis with their disease, and not recognize that information about “COPD” applies to them.)
Last but not least, doctors themselves must ensure they are familiar with common risk factors and core symptoms of significant chronic diseases, so they can ask the questions and provide information that helps patients seek and receive the best possible care.
Effective doctor-patient dialogue has been called an essential clinical function, and includes not only the ability to gather the facts needed for an accurate diagnosis, but also shared perceptions and feelings regarding the patient’s problem, treatment and support. We need to be doing more to support and encourage patients to share any changes in their health or daily activities with their doctors, so that COPD can be caught earlier.
My hope is that more people will take note of their breathing – or their loved ones’ breathing – and will talk to their doctors honestly about what they are experiencing. For patients suffering with COPD, open conversation is the first step to treatment, and the hope for a better, healthier, future.
Deborah Long, MD, is an Executive Medical Director at GSK and the US Medical Affairs Lead for COPD at GSK. At GSK, she is responsible for medical oversight of GSK’s COPD portfolio in the US. Her specialties include pulmonary medicine, critical care medicine, internal medicine and hospitalist medicine. Deborah graduated from the University of Massachusetts Medical School and completed her residency at UNC Hospitals Chapel Hill.
Photo: Flickr user Fuente Com Salud
