By Ana Sanchez, M.D., Community Hospice of Northeast Florida
When it’s hard to breathe, it’s difficult to think of anything else.
Floridians who live with Chronic Obstructive Pulmonary Disease, or COPD, may know that all too well, especially this time of year.
As temperatures across our state take a momentary wintery dip, COPD’s signature symptoms—shortness of breath, coughing and wheezing induced by emphysema or chronic bronchitis—will flare up for some in proportion to the chill. Likewise, our steamy, humid summers also can prove dangerous for those who live with this incurable disease. These symptom manifestations will be unique to each person.
How many Floridians ride this climatological roller coaster?
The Centers for Disease Control and Prevention’s Behavior Risk Surveillance Survey pegs Florida’s COPD prevalence rate at 7.1 percent1. That’s nearly 1.4 million Floridians whose daily activities, relationships and emotions are impacted by this chronic condition, America’s third leading cause of death, with symptoms that can endure for years or decades.
When do these individuals catch a break, or in this context, a breath?
As a hospice physician, it is my goal to affect the best life possible for the patients and families I serve. While there are people living with COPD whose symptoms will qualify them for a hospice admission, quality of life can be a challenge well before then, too, starting at initial diagnosis. You may encounter these individuals regularly, as patients, clients or even caregivers to others.
How can we help them live better?
Customized medication regimens and action plans coordinated by a medical professional are the first steps to reducing exacerbations and restoring clear breathing. Bronchodilators, anti-inflammatories, combination medications, antibiotics and vaccines may lessen symptoms and help avoid infections such as the flu or pneumonia. Because of the complexity of these custom regimens, elders’ caregivers should be well versed in medication management.
Some COPD patients also may benefit from supplemental oxygen, an adjunct therapy that can help people experience a wider range of recreational activities by improving their mobility. Available through a physician’s prescription, today’s oxygen delivery technology makes getting around a much easier proposition, through the use of lightweight, portable concentrators.
Pulmonary rehabilitation, clinical trials and surgical interventions also can be viable options for patients who qualify for them.
Another intervention that can help is palliative care. This medical specialty helps relieve the symptoms, pain and stress of a serious, chronic illness. It also gives patients and caregivers the opportunity to better understand their condition, complete advance care plans, and develop a road map for future care decisions. While hospice is a specific type of palliative care reserved for people who have a time-limited life expectancy, as some COPD patients surely will, palliative care is appropriate at any stage following diagnosis. Hospitals and hospice providers frequently offer these services, for which Medicare, Medicaid and private insurance may cover some costs.
Hospice care may be an option to relieve pain and restore comfort when the disease reaches end-stage status, at a life expectancy of 12 months or less. Some hospice providers have developed unique clinical protocols for COPD, with dedicated respiratory therapists and comfort kits containing key medications to reduce exacerbations and bring quick symptom relief.
Still other hospice providers, including several in Florida, are participating in a five-year Centers for Medicare & Medicaid Services Innovation Center research effort that launched in January, the Medicare Care Choices Model (MCCM). For Medicare beneficiaries who meet CMS criteria, including hospice eligibility, the MCCM offers hospice-like supportive care to patients concurrently with curative therapies as coordinated by their primary care providers. COPD is one of four terminal diagnoses accepted through the model.
As with most chronic illnesses, COPD can drastically affect the lives of those who live with it, and those of their caregivers. Support resources are plentiful, however, and should be tapped to prevent caregiver burnout and create a lifeline to people and institutions that can help. Groups such as the American Lung Association offer telephone help lines, in-person support groups like the Better Breathers Club in area hospitals, and online communities. The National Institutes of Health’s Breathe Better Network members offer COPD public outreach and education, and the Florida COPD Coalition is another resource for provider education events and patient support groups.
And let’s not forget about the root cause of this affliction for so many, cigarette smoking, which is a factor in up to eight out of every 10 COPD-related deaths2. Cessation programs are readily available through employers, houses of worship and online communities.
As health leaders and elder advocates, we all must play a role in helping those in our care live their best lives possible. With education and early intervention, we can make sure our neighbors with COPD breathe easier all year long.
Ana Sanchez, M.D. is chief medical director for hospice services at Community Hospice of Northeast Florida in Jacksonville.
Community Hospice of Northeast Florida strives to improve the quality of life for patients and families, and to be the compassionate guide for end-of-life care in their community. Find out more at http://communityhospice.com.
- COPD Foundation. COPD Statistics Across America. Washington: COPD Foundation, 2013 [accessed 2016 Jan. 26].
- S. Department of Health and Human Services. The Health Consequences of Smoking—50 Years of Progress: A Report of the Surgeon General. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2014 [accessed 2016 Jan. 26].