Patient education is critical for self-monitoring of COPD disease progression.
Jeffrey D. Dunn, PharmD, MBA: Obviously, if a patient can’t breathe, they’re going to seek help. Or if they have an exacerbation and have to go to the ED [emergency department], we know what that means. Mike, I’ll start with you. Whether it’s the provider or a care manager, what education can we provide to patients so that they’re better at self-monitoring their progression outside the clinic?
Mike Hess, MPH, RRT, RPFT: There are a lot of tools that people can use. Courtney mentioned the CAT [COPD Assessment Test]. That’s available. It’s on the internet and on various apps. The COPD Foundation has a free app that people can use to measure themselves and check their own progress. I’ve known people who’ve kept journals. There are a lot of tools that people can use, including action plans. There are a lot of things that people can use to help them understand how their symptoms are day to day, what their triggers may be, and if there are certain places they go or certain times of day when their symptoms are worse.
Another thing I’ll highlight is the importance of peer education. As RTs [respiratory therapists], doctors, nurses, and clinicians, there are a lot of things that we can tell people to do. But I’ve found that a lot of folks are most willing to learn from other people who have walked the same path that they’re on rather than somebody from the outside looking in. I always encourage people to seek in-person or online support groups, where they can tell stories and ask questions to people who’ve had similar experiences, and benefit from peer education.
Jeffrey D. Dunn, PharmD, MBA: Courtney, Rey, do you have anything else to add? Is there anything else we can do that hasn’t been mentioned to make these patients more self-reliant?
Courtney Crim, MD: I want to amplify what Mike said as it relates to the action plans. We talk about action plans frequently as it relates to asthma. Patients with COPD [chronic obstructive pulmonary disease] should have an action plan from the standpoint of what things they can and should do if their symptoms worsen beyond the day-to-day variation that they recognize their symptoms would do. It could be having a standing prescription for antibiotics or systemic corticosteroids for an exacerbation, so they don’t necessarily have to contact me, as a physician, beforehand. They can have a standing order. They can start taking the medication at the earliest sign and then contact me to let me know what’s going on. They can do things to decrease their exposure to triggers and decrease risk factors.
These are things that could be part of an action plan that a patient can take control of. By having this ongoing dialogue, it could be an iterative process to say, “These things are happening. This is what we can do or these are things you can do.” We can have them set in place, and therefore you’ll know what to do to be participatory in the management of your own condition.
Jeffrey D. Dunn, PharmD, MBA: That’s perfect.
Reynold Panettieri Jr., MD: I completely agree. Group therapy is important support. Get people into group therapy with other patients with COPD. Pulmonary rehabilitation early in the process is incredibly important. I’ve never seen people so energized than after they’ve done a pulmonary rehab program. They immediately get a sense that there’s optimism. “Despite how sick I am, I can do these activities of daily living without getting dyspneic, or shortness of breath.” It’s really important.
Also, recognize that COPD is a self-image problem. If you’re wearing oxygen 24-7, that doesn’t feel attractive. Immediately, people feel, “This was because I smoked and I did something that affected my health.” Truth be told, many people who develop COPD will continue to have ongoing inflammation even 2 or 3 decades after they stop smoking. They think, “I stopped smoking, so I’m going to be fine.” That isn’t the case. There are still problems that can develop from smoking that is displaced by decades.
Expectations are important. One question I like to use is really interesting. I ask the patient, “What does success look like to you?” Of course, I’m not asking them. “I don’t want to have COPD. I want to be cured.” Often you’ll find that they have a much more realistic goal that I didn’t realize. “I want to go to my son’s wedding. That’s success. That’s in 3 months, and I’m worried whether I could live that long.” You have to define the patient’s view of success and expectations and be very honest with them. I encourage. I love when my patients go to Dr Google. Dr Google knows everything. I actually like Dr Google because it offers an opportunity for discussion. There’s nothing worse than sitting there and telling a patient what you think and then getting no feedback. Somebody engage.
Jeffrey D. Dunn, PharmD, MBA: It shows that they’re involved and engaged and at least trying to figure stuff out.
Reynold Panettieri Jr., MD: It’s great.
Jeffrey D. Dunn, PharmD, MBA: Absolutely. I love those comments. I totally agree. It’s about engagement. It’s so important to understand and to reiterate that this is a multisystemic disease state, and we can’t just tell people what to do. They have to be involved in the process. Generally speaking, it’s much better to prevent than to treat. I love those comments about engagement and action plans.
Transcript edited for clarity.