VIDEO: Approaching patient conversations following COPD diagnosis

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Good day everyone, I'm Dr. Jamie Rutland here to discuss COPD with you. When we're talking about COPD and how we initially discuss COPD with our patients, one of the issues that I have is a lot of these patients really don't understand what COPD is. And I also would like to say that at sometimes physicians, we just don't spend the time thinking about what COPD is. So we have to understand that COPD, which stands for chronic obstructive pulmonary disease, is either emphysema, which is dead lung, or chronic bronchitis, which is inflamed pipes that carry air to the lung, but these pipes produce mucus causing a cough, right? These patients need to have that cough for like three months, a couple times a year, and that's how we diagnose chronic bronchitis.

When I think about these two different conditions, they're managed really differently. Emphysema, which can really only be managed with oxygen supplementation, but you can think about lung volume reduction by using the bronchial valves or something like that. And then you have the chronic bronchitis, which is managed with the inhalers, whether you are using a single medication inhaler like an albuterol, or a dual medication inhaler, like a long-acting beta-agonist/inhaled corticosteroid, or a triple therapy where you have a long-acting beta-agonist, an inhaled corticosteroid, and a long-acting muscarinic antagonist. So I think that when we think about COPD, we have to tell our patients, "Hey, listen, you have chronic bronchitis or you have emphysema, or you have both, and this is why we're managing it in X, Y, Z way." I think that that's very, very, very important.

When we're looking at younger patients, and in my head, I'm thinking of patients that are younger than the age of 40 that have been told they have COPD. Yeah, these are patients that I completely work up because odds are they don't have COPD, especially when these patients come in and they say they have no significant history of smoking, and they say they've been told they have COPD. Those are patients that I work up. I get an HRCT to look for evidence of interstitial lung disease or to see evidence of chronic bronchitis where their bronchials will be thick, those walls will be thicker or you'll see some mucus in there. But these are the patients that I spend a significant amount of time actually looking up and thinking of alternative diagnoses. If it is a younger patient with emphysema, then I'm looking at genetics, right? Do they have Alpha-1 antitrypsin disease? Do they have evidence of a family history of these individuals, brothers, sisters, mothers, fathers going through similar types of findings at similar types of ages?