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    How to improve care, hit quality metrics for COPD patients


    However, to help patients with COPD, Lohr says physicians must obtain accurate information regarding the last time the
    patient was short of breath or how many cigarettes the patient smokes per day. 

    During each patient encounter, Mahnensmith tries to make the patient feel comfortable through eye contact, speaking slowly, and pausing to answer questions in the hopes that patients are at ease disclosing information about symptoms and habits. 

    Questions must also address patient limitations. For example, physicians should think about each patient’s ability to manually operate an inhaler, says Mahnensmith. Some people don’t have the dexterity to use a pump inhaler and require a breath-activated inhaler instead, he adds.


    Focus on patient education and management

    Once physicians identify a course of treatment, patient education becomes critical. For example, when Mahnensmith demonstrates how to use long-acting bronchodilators, he asks patients to repeat the instructions.

    He also ensures that patients understand when to use this type of inhaler rather than a rescue inhaler. This involves explaining that long-acting bronchodilators help manage and control COPD symptoms and underlying inflammation, and that patients must use them every day. Rescue inhalers are short-acting devices that quickly address trigger-induced bronchospasm. 

    In addition to providing detailed instructions, physicians should observe patients using the inhaler to determine whether their technique is correct, says Steven Weinberger, MD, a pulmonologist. 

    Mahnensmith watches patients use their inhalers, and asks them to keep a
    record of when they use them. He also monitors preventive inhaler refills and contacts patients who don’t request refills within 60 days. Most inhalers include a fixed number of doses, so when refills aren’t requested, it indicates a patient isn’t using his or her inhaler as prescribed (typically twice per day).

    Many patients must also know how to use a nebulizer, says Lohr. “We have certainly seen anecdotally that poor maintenance of the nebulizer can bring patients back to the hospital,” she adds.

    Monitoring outdoor air quality is another topic physicians should discuss with patients. For example, Mahnensmith encourages patients with COPD to pay attention to allergy counts and stay inside when counts are high, if possible. Reminding patients about indoor air quality—particularly ensuring the environment is free of dust and mold—is also important, he says.

    Finally, make sure that patients know what to do when they experience signs of an acute COPD exacerbation, such as worsening shortness of breath or worsening sputum production, says Weinberger. 

    Mahnensmith tells patients to call him before going to the hospital or an urgent care center so he can determine whether they truly need urgent attention or simply a reminder on how to use their rescue inhaler. He also instructs patients to contact him when they begin to use the rescue inhaler more than twice a day, a symptom indicating active inflammation and requiring assessment and additional care. He records these steps in an action plan that’s customized for each patient. 


    Lisa Eramo, MA
    Lisa Eramo, MA, is a contributing author for Medical Economics.


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