Earlier this year, the National Heart, Lung, and Blood Institute released their 2018 COPD report: “Tracking Perceptions of the Individuals Affected and the Providers Who Treat Them.” AARC Member Mike Hess, RRT, RPFT, shares his insight on the report.

Key Findings

“I think the key finding from the report is that COPD is still in search of an advocacy leader and a good ‘branding’ campaign,” Hess said.

He believes most patient awareness and understanding of the disease is still low.

“People still don’t understand it’s treatable, they don’t understand who it affects, and under-recognition and under-reporting of symptoms are still hampering early diagnosis,” Hess said. “We’ve seen amazing advances in therapy, whether it’s pharmacological, surgical/bronchoscopic, or social, but many of them remain under-utilized.”

Hess suggests that research dissemination to clinicians, outreach to policymakers, and public education are the factors that directly affect awareness levels. Improving these can improve patient and community awareness for COPD.

“People won’t ask for treatments they don’t know about or don’t realize they could benefit from,” Hess said.

Three key takeaways

#1 – Respiratory therapists are critical in screening for COPD and detecting problems with therapy plans.

“We’re the ones seeing people come back to the ED or the medical wards month after month; we’re the ones that need to be asking, ‘why?’” Hess said.

Hess recommends RTs take a more active care coordination role. This will help in:

• Figuring out if people have access to their therapies (especially medications).
• Determining if people understand how to use their medications.
• Understanding what other barriers patients may face.

“We need to make sure RTs everywhere have the tools they need to not only pick up on these patterns but to advocate for their patients,” Hess said.

#2 – Need for clinical support.

“There is a tremendous unmet need for clinical support in the realm of COPD, particularly in primary care,” Hess said.

Hess references Graph 6 on page 13 of the report, noting that less than 1/3 of people reporting COPD-related symptoms to their doctor were given a spirometry test. Furthermore, only 29% of respondents in 2017 were given tobacco counseling while 26% and 21% had discussions related to asthma and COPD, respectively.

“At best, that’s telling us that whatever education is going on in the primary care world is ineffective and unmemorable,” Hess said.

In addition, Hess points out that Graph 9 (page 17 in the report) shows that the most significant factor for primary care physicians to not test a patient was that testing would not affect their management of the patient.

“Which is troubling on several levels,” Hess said. “I know we’ve had around a half-dozen people in our office alone pick up speech or other upper-airway therapies because they got an ENT referral on the basis of spirometry results.”

#3 – Improved distribution for patient and caregiver educational resources.

“Significant portions of these populations are asking for more information about therapies, research, and even basic disease education; the stuff is out there, so why isn’t it being utilized?” Hess said. “We need to be asking what role RTs can play in public health, in order to get the information out there more effectively.”

Application for RTs

“There are questions that every RT can ask themselves immediately the next time they see one of their people with COPD,” Hess said.

He suggests to:

• Take a minute to double-check inhaler technique, and to double-check your own instructions.
• Take a moment to ask your patients if they’re having trouble getting or using their medications.
• Ask your patients if they’ve heard of pulmonary rehab.
• Finally, seek first to understand. (It’s a habit of highly successful people for a reason, as Hess points out.) Don’t assume why your patient hasn’t filled their prescription. Find out why and see what you can do to help.

“One of our most important roles in patient care is that of teacher,” Hess said. “Teach your patients to be their own best advocates when they go see their PCP or pulmonologist and make sure they’re armed with the best available information to guide their own care.”

Going forward

“We cannot fix problems we do not understand,” Hess said. “COPD has been the third or fourth leading cause of death in the U.S. and around the world for many, many years. Most of the other leading causes of mortality have seen declines, but COPD has been essentially stagnant.”

For Hess, this happened because of an era of therapeutic nihilism—the mindset that nothing was going to do any good, so why bother. While he believes we’ve moved out of this era, we still need to figure out why COPD is such a heavy burden on health care.

According to Hess, “reports like this give us insight into things we need to address, like understanding of early-warning symptoms so they can be reported to providers or reducing the stigma of tobacco addiction so that people aren’t afraid to talk about their habit.” Once we understand why things are the way they are, he feels we can start to make them better.


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