Asking the Right Questions When Assessing for COPD

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The MD Magazine Peer Exchange “Expanding Treatment Options: The Latest Developments in COPD Therapy” features a panel of physician experts discussing key topics in COPD therapy, including risk factors, personalized treatment, preventive measures, new combination therapies, and more.

This Peer Exchange is moderated by Peter Salgo, MD, professor of medicine and anesthesiology at Columbia University and an associate director of surgical intensive care at the New York-Presbyterian Hospital in New York City.

The panelists are:

• Byron Thomashow, MD, professor of medicine at Columbia University Medical Center, medical director at the Jo-Ann LeBuhn Center for Chest Disease at New York-Presbyterian Hospital, and chairman of the board of the COPD Foundation
• Neil R. MacIntyre, MD, clinical chief of the Pulmonary/Critical Care Division, medical director of Respiratory Care Services, and professor of medicine at Duke University School of Medicine
• Barry J. Make, MD, director of Pulmonary and Respiratory Care for National Jewish Health and professor of medicine at the University of Colorado School of Medicine
• Nicola A. Hanania, MD, MS, associate professor of medicine and director of the Asthma and COPD Clinical Research Center at Baylor College of Medicine

When assessing a patient for possible chronic obstructive pulmonary disease (COPD), it’s important to ask the right questions, especially in the limited amount of time that many physicians nowadays have to spend with their patients.

According to Dr. Thomashow, it’s not enough to ask a patient, “How is your breathing?”

He said, “If the patient has cut back on his activity enough, he may not often be short of breath. That’s the wrong question. If you ask him about his cough, you may assume his cough is a normal smoker’s cough or an allergic cough and pass on that as well. What you really want to know is how is he doing compared to how he was a year ago. Is he able to do what he could do a year ago? Is he able to do what he wants to do?”

This approach is akin to using the patient as his or her own control.

This focus on the patient must also extend to medication selection. When thinking about the best treatment approach, physicians must consider a range of factors specific to that particular patient. For example, “compliance and adherence with medication is a major issue. This can be affected by the cost and affordability of medications and insurance coverage. All these should be kept in mind. The other thing we have to consider is can the patient actually use whatever device we’re treating them with,” said Dr. Hanania.