Talking to Patients about Shortness of Breath

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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

In this opening segment, the panelists discuss the importance of talking with patients about their symptoms in order to determine appropriate, individualized therapy for patients with COPD.

Dr. MacIntyre said “there is a wide variety of different kinds of therapy and it’s helpful to individualize the therapy for each individual patient.” He advised clinicians to rely not only on the standard testing and questionnaires, but to ask the patient what his or her problem is and ask them to describe their symptoms.

“Shortness of breath is a common complaint, so ask patients about when they become short of breath. During which activities? Is it minimal activities? Does it occur many times of day or does it occur one time a day?” said Dr. Make.

“Another complaint besides the sort of day-to-day shortness of breath that I think is really important for us to recognize is the exacerbation issue,” said MacIntyre. A flare up that 30 years ago “may have only knocked them out for two days is now knocking them out for two months and often sends them to doctors’ offices, to emergency departments, to hospitals. So, as we think about evaluating these patients, I think one of the key things you’ve got to look at and ask them is ‘How often do you have to access the medical system and deal with these flare-ups that can be incredibly debilitating?’”