Patient care reaches far beyond the hospital doors. And it’s through patient education opportunities where your care exponentially expands. Mike Hess, MPH, RRT, RPFT, a lung disease coordinator in Michigan, shares his tips in looking beyond the basics when it comes to COPD patient education opportunities.

Know your medicine

“First and foremost, I always recommend people check and double-check with their clinicians so that they know their medication regimens inside and out,” Hess said. “Including inhaler technique,” he noted.

Hess tends to look at an exacerbation as a failure point in someone’s regimen.

“This isn’t always the case of course,” he said, “but it is always a great opportunity for quality control and evaluation.”

Hess admits that the transition process from hospital to home can be hectic and confusing.

“Often people leave on the same regimens that brought them into the hospital in the first place,” he said.

Hess recommends the following patient medication checks:

• If someone is on a powder inhaler, they should have their peak inspiratory flow rate checked to make sure it is sufficient and the patient can break up the powder into an inhalable form.
• If they’re on an MDI or SMI, their coordination and technique should be observed, and their peak flow measured to make sure it isn’t too HIGH for the aerosol.
• And, if they’re using a nebulizer, they should have a solid understanding of cleaning and maintenance.
• If someone finds themselves in the hospital a lot, they may even want to discuss some of the non-inhaled therapies that are becoming more integrated into therapy recommendations.

Get moving

“Exercise is often overlooked as an important component of a symptom management plan as well,” Hess said. “However, as Dr. Jean Rommes, a national COPD advocate and patient herself once told me, ‘the medications help me exercise but the exercise helps me live.’”

What if pulmonary rehab is not an available option?

“Most RTs likely know that pulmonary rehab is vastly under-utilized, and there can be a number of barriers for referring people to local programs and following up with them, but there are a number of exercises one can do at home to rebuild respiratory strength,” Hess said, explaining that instructional videos can often be found online as well. “Of course, they should be mindful of getting provider clearance before starting any exercise program, but it is absolutely essential to stay as active as possible!”

Look for gaps

According to Hess, this is a good time to see if there are any diagnostic gaps that need to be addressed.

“Many with COPD can have overlaps with other conditions,” Hess said, noting that asthma is probably the most well-known overlap area, and people may not be sufficiently managing their asthma/allergy symptoms.

Another condition of concern is sleep apnea.

“It can be hard to tell whether someone is waking up because COPD is making them cough and wheeze, or whether they’re actually having apnea/hypopnea events,” Hess said. “In either event, lack of restful sleep puts people at much higher risk of adverse outcomes, like more exacerbations.”

And finally, Hess strongly recommends getting a high-quality spirometry if it hasn’t been done, as well as blood tests like alpha-1 antitrypsin deficiency screening.

Patient care is active and a two-way connection. Helping your patients learn about their condition, understand how to manage it along with what other conditions may impact their symptoms, magnifies the care you deliver each day.
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