VIDEO: Utilizing shared decision-making, collaborative care in COPD

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When I'm speaking to patients about their COPD, I do involve shared decision making. So I will give patients options, right? I will say, "Well, which triple therapy do you want to use? Do you want to use this one, which is twice a day, Or this one, which is once a day? Which one are you going to be more compliant with?" Some people like to use things twice a day because they like to have something and feel like they're doing something for themselves, right? And they feel like if they use it once a day, they're not doing enough for themselves. So you give them the twice a day medication. Some people are like, "Nope, I'm not going to use it. I'm feeling great. Like, I just want something to use once a day." You give them the once-a-day triple therapy. That's how I decide and that's how I involve the patient. And then I start to ask them questions.

If I can see reactive airway disease and this patient has reversible airway disease, even if they're 75, they have a history of smoking. If they have reversible airway disease, I will give them a diagnosis of asthma because they qualify as a diagnosis of asthma, which opens up their therapies to other inflammatory molecules that we can use. And I think that that's important because at the end of the day, we're trying to help patients. We're trying to make sure that patients feel better. We're trying to make sure that patients gain confidence with being able to go outside and do those things.

My grandfather had COPD, he had severe COPD. When he came to my college graduation, he was on oxygen. When I was in medical school my first year, he couldn't make it to our white coat ceremony because his emphysema was so bad. He eventually died three months later from his emphysema, secondary to his smoking history. And he was 86 when he died, 87. And I was very sad, but I don't regret it because he was using inhalers every day. And this is probably why I'm a pulmonologist today, because the inhalers that he used, and he had a good doctor and his doctor told him to use his inhalers, he was on oxygen. So these are the things that I think is important. I think it's very important to have that shared decision making.

I think it's also important to collaborate with primary care providers. As a specialist, I know that the primary care provider does not have the information that I have. I go to every conference. I read almost everything that comes through on my desk. I know that a lot of primary care physicians can't keep up with the latest and greatest in COPD. So the primary care physicians in my area know that I'm around. They can call me, they can text me, they can type and text me, which I'm sure a lot of us have now, and they can ask me questions in regards to what to do about certain patients. So these are the things that I do. This is how I collaborate with my primary care providers. They can even contact me on social media, which I use a lot of.