Article by Jordan Rosenfeld
When Chronic Obstructive Pulmonary Disease (COPD) patients come to visit Dr. Sachin Gupta, M.D., they are comforted by his approach towards chronic-care management. Rather than solely utilizing medications to manage the core disease, the San Francisco-based pulmonologist is known for his holistic approach toward patient care.
“COPD affects so much more than just the patient’s lungs,” Gupta said. “We know that COPD patients are affected with higher rates of anxiety and depression, in debility and deconditioning of their muscles. We even know there are higher rates of cardiac disease in patients.”
In fact, simply addressing a given symptom of COPD—such as shortness of breath—may solve one problem but create others. For example, an ongoing clinical trial in Singapore found that while treating patients with oxygen improved their breathing, the bulky, home oxygen tanks also limited patient mobility and social engagement, essentially tying them to their homes. Reduced physical activity levels in COPD patients is shown to lead to reduced quality of life and linked to increased admission rates to hospital.
Gupta said he refers patients who qualify to pulmonary rehabilitation (PR), a form of rehabilitation and education that consists of three key pillars: exercise, education and stress management.
PR is especially helpful for patients who are stuck in what Gupta calls “the vicious cycle” of feeling as though they can’t exercise because they can’t breathe well, which leads to muscle atrophy and further reinforces their limited mobility. “Pulmonary rehabilitation addresses that and breaks the cycle every single time,” he said.
PR programs are generally six to eight weeks and hosted by a respiratory therapist in a small group setting. Guest lecturers may come in to teach lifestyle habits or medication management, and peer support offers a sense of community. Gupta believes both education and exercise are equally important in empowering patients.
Patients learn best practices such as how to safely transport oxygen tanks without tubes getting tangled, how to keep track of multiple inhalers and how to use them correctly, he said.
“The fifteen minute visit that I have with patients is not enough time to cover inhaler use, inhaler education and then test and assess,” Gupta explained.
Care for your patient as a whole person
PR is a crucial part of what pulmonologist Laran Tan calls “whole person care.”
“We treat the mental, physical, and spiritual aspects of COPD patients,” he said. Tan, who is Director of the Comprehensive Obstructive Airway Disease Program at Loma Linda University Health in California said that PR also offers a level of camaraderie and support through its group format.
“The group support is critical to be able to see what other people are struggling with and hear their viewpoints and how they overcame challenges,” he said.
The only downside of PR is that it isn’t well reimbursed in every state. Tan said the academic institutions are the most likely to offer PR, many of which also have lung transplant centers.
Aside from engaging in policy advocacy to let politicians know that PR is worthy of reimbursement, Tan said that doctors can help advocate for patients by finding the nearest PR facilities. If those are too far, or would require more time than a portable oxygen tank can last, Tan said there are strides being made toward at-home versions of PR utilizing YouTube or DVDs.
“We may see live group exercise PR regimens by teleconference,” he said. These would still require some form of healthcare provider supervision, which could potentially be done by tele-health, and might require patients to purchase equipment such as a stationary bike or treadmill, but it is an alternative he’s hopeful about.
Customize care plans
In lieu of or in addition to PR, physicians may be able to refer some COPD patients to occupational therapy (OT), which focuses on strategies to help improve quality of life and level of functioning of patients.
Brittany Ferri, MS, and OTR/L, CCTP runs her OT private practice in Rochester, New York. She said OT is especially useful if there is a specific issue that a COPD patient is struggling with that they need support around, from basic self-care to being able to take short walks.
Ferri often teaches pursed lip breathing to COPD patients—in through the nose, out through the mouth. “It better helps the oxygen attach to your blood cells and gives you a feeling of energy so the shortness of breath goes away,” she said.
But she also recognizes that something as simple as a new breathing technique can be challenging for some patients, so she teaches caregivers and family members how to support a patient, so they’re not dealing with it in isolation, where they may be prone to frustration.
Whether physicians are able to refer patients to PR or OT or not, Ferri recommends they “empathize with the patient and find out how this disorder is affecting their life, because that will help specifically tailor recommendations. No two people are going to be the same.”
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