Making the Most of Your Doctor’s Appointment

Download our Making the Most of Your Doctor’s Appointment WYNTK

The average visit with your healthcare provider is about 20 minutes. You will want to make the most of your time with your healthcare provider. Here are several strategies that we recommend:

Preparing for your appointment

  1. Bring a list of current medications and make a copy for your healthcare provider.
  2. Prepare a list of important questions to ask during your appointment.
  3. Provide information or results you obtained from other health resources.
  4. Include others, such as your significant other and/or caregiver, in preparing for the appointment.

During your appointment

  1. Ask your most important questions first.
  2. Be honest when describing symptoms.
  3. Create an action plan with your healthcare provider for managing your condition and dealing with episodes.
  4. At the end of the appointment, review any decisions and next steps with the medical professional.
  5. Take notes during the appointment.

After your appointment

  1. Maintain communication with your healthcare provider.
  2. Get a second opinion from another healthcare provider. Most doctors encourage them.

Contacting a Specialist or Primary Care Provider

  • Most primary care physicians encourage the advice of a specialist.
  • If you have not created an action plan with your primary care provider, do so with your specialist.
  • If you are experiencing a medical emergency, call 911.

Caregiver Support and COPD

Download our Caregiver Support and COPD WYNTK

Caregivers can be important to people living with chronic obstructive pulmonary disease (COPD). Caregivers may perform a variety of duties, including help with medication management and medical or nursing needs, often without any professional training. It is important that caregivers have the support they need in order to take care for their loved ones. We have listed recommendations from healthcare professionals to support caregivers in this role:

Develop a plan for care:

  • Prepare and participate in medical appointments with your loved one. For example, develop a list of questions for your healthcare provider together.
  • Work with your loved one and healthcare provider to develop a COPD Action Plan, a plan for managing the condition and dealing with episodes.
  • Maintain regular communication with healthcare professionals.
  • Create personal reminders on how to properly use medication and medical devices such as nebulizers, inhalers, oxygen equipment, etc.

Maintain important health information:

  • Maintain up to date medical history and medication lists for you and your loved one to bring to medical appointments; it may be useful to keep a medication list in your purse or wallet.
  • Create a central location for all legal and health documents accessible to you and family members.

Research available resources:

  • Become familiar with health resources in your area such as pulmonary rehabilitation centers, oxygen providers, home health companies, etc.
  • Familiarize yourself with any senior support services that may be available in your village/township such as transportation support, meals delivered to your home, etc.
  • Consider other supports: a patient advocate may be able to join your loved one at medical appointments; and a financial consultant may be able to support with money management for seniors.

Identify additional support:

  • Establish a back-up/secondary caregiver and provide him or her with all necessary health information.
  • Develop a healthcare power of attorney for you and your loved one.
  • Join a support group.
  • Remember to talk to family and friends.

Navigating COPD Care

Download our Navigating COPD Care WYNTK

It can be difficult to navigate the complex health system of hospitals, insurance coverage and healthcare providers when managing COPD.

In 2014, the Centers for Medicare and Medicaid Services (CMS) began an effort to improve quality of care by assessing hospitals and healthcare providers on their ability to reduce hospital readmissions within 30 days after an initial COPD exacerbation admission. According to data, 1 in 5 patients admitted to the hospital with a COPD exacerbation is readmitted within 30 days of discharge.

The following are strategies we recommend for you to better navigate the healthcare system and avoid hospital readmission:

Tips to help you navigate the healthcare system:

  1. Work with health system care management, discharge coordinator and family/caregiver liaison or advocate to develop a COPD management plan
  2. Don’t be afraid to ask questions of healthcare providers (refer to RHA’s Publication, “Making the Most of Your Doctor’s Appointment”)
  3. Research healthcare services to ensure they meet your needs
    1. Know which pulmonary rehabilitation centers are available in your area
    2. Become familiar with home health companies
    3. Research medical equipment and oxygen companies
    4. Become familiar with extended care facilities
  4.  Understand your long-term health insurance

Tips to avoid hospital readmission:

  1. Develop a COPD management plan
  2. Review medication use and technique with your healthcare providers
  3. Create personal reminders on how to use proper medication technique/ medical devices (i.e., nebulizers, inhalers, etc.)
  4. Review your hospital discharge plan with family/ caregiver advocate and discharge coordinator
  5. Prepare for in-home care following a hospitalization
  6. Know what resources are available (for example extended care facilities)

COPD Flare-Ups

Download our COPD Flare-ups – What You Need to Know

A COPD flare-up (or an exacerbation) can be scary for both the person living with COPD and his or her caregiver. Sometimes COPD flare-ups can be minor, but sometimes they can be severe. It’s important to know what a flare-up looks like and how to respond. This resource is designed to help people living with COPD know how to prevent a flare-up, prepare for a flare-up and respond to a COPD flare-up.

 

Review the signs of a flare-up

It is important to know how to recognize the signs of a flare-up. Below is a list of things to look for:

  • An ongoing or more severe cough;
  • A cough that produces a lot of mucus;
  • Increased shortness of breath, especially with physical activity or when resting;
  • Wheezing or a whistling or squeaky sound when breathing;
  • Chest tightness;
  • Cold or flu-like symptoms.

 

Know how to prevent a flare-up

Early detection is important, be aware of the signs and symptoms above, call your doctor at the first sign of a change to your baseline health. You should also:

  • Avoid others that are sick, when able;
  • Practice good hand washing;
  • Speak to your doctor about proper nutrition and pulmonary rehabilitation;
  • Seek out information to help you or your loved one stop smoking;
  • Get the proper vaccines (e.g., flu and pneumonia vaccines).

 

 

Know how to prepare for a flare-up

Even with the best prevention practice, a flare-up may still occur. It is important to focus on planning. Being prepared will help you and your caregivers know what to do in the event of a flare-up:

  • Speak with your health care provider to determine the best medications for a flare-up;
  • Know your triggers and avoidance strategies (e.g. make your home smoke-free, treat allergies, etc.);
  • Keep your medication lists current and on hand at all times;
  • Know the locations of emergency rooms or urgent care facilities and identify a Power of Attorney (POA);
  • Prepare your home with a stock of food, water, medications and medical device supplies.

 

Know how to respond to a flare-up

  • Track and review signs and symptoms; identify when a symptom is not normal or may be an emergency (i.e., chest pain, fever, shortness of breath not subsiding with rest, etc.);
  • Contact your doctor;
  • Have your current list of medications on hand;
  • Communicate well with caregivers;
  • Use a COPD action plan and share it with your caregivers and doctors.

 

If you are experiencing a COPD emergency, which may include symptoms such as fast or irregular heartbeat, difficulty walking or talking, breathing fast and hard, call 911 immediately.

Oxygen Therapy for COPD

Download the Oxygen Therapy – What You Need to Know PDF.

 

There are changes that occur in the lungs of Chronic Obstructive Pulmonary Disease (COPD) patients. Two large changes are:

  • Narrowing of the airways
  • Damage of lung tissue

These changes make it harder for patients to breathe. The amount of oxygen that reaches the blood is not enough to meet the body’s needs. Oxygen therapy can help control this problem.

Signs and symptoms

There are signs and symptoms that should alert patients to the possibility of needing supplemental oxygen and may prompt them to visit a healthcare provider. These signs and symptoms are:

  • Shortness of breath
  • Decreased exercise tolerance
  • Fatigue and dizziness

Testing oxygen levels

Your healthcare provider will be able to tell if someone needs supplemental oxygen by testing the blood oxygen level.

Benefits of oxygen

More than 15 hours per day of oxygen therapy in patients with chronic respiratory failure has been shown to increase survival and improve quality of life. Oxygen therapy also improves exercise capability, sleep, and mental performance.

Types of oxygen systems

Oxygen concentrator

  • The most commonly used system at home.
  • It produces oxygen by concentrating the oxygen that is already in the air and eliminating other gases.
  • A portable version is available that allows user flexibility outside of the home.

Compressed oxygen cylinders

  • Small enough to be carried in small side packs.
  • Weigh less than eight pounds.

Liquid oxygen systems

  • Allows larger amounts of oxygen to be stored in smaller, more convenient containers than compressed oxygen.
  • Cannot be kept for a long time because it will evaporate.

 

This content is provided for informational purposes only and does not substitute for medical advice.

Nebulizers

Download the Nebulizers – What You Need to Know PDF.

 

Nebulizers are small air compressors used to administer medicine. Users put a nebulizer mask on their face or use a mouthpiece to breathe in mists of air mixed with medicine. Nebulizers do not require oxygen tanks; they use the air in the room.

Who should use a nebulizer?

A health care provider may recommend a nebulizer for a variety of reasons. Nebulizers are often prescribed for infants and children who are not coordinated enough to use an inhaler. Also, the liquid vials of medicine used with nebulizers can be less expensive than purchasing the same medicine in an inhaler.

However, nebulizers are not always the best option for someone with asthma. They are not as portable as inhalers, so someone who only has a nebulizer may not have easy access to their medicine if their asthma acts up away from home. Some asthma medicines are also not available for nebulizers.

How do I use a nebulizer?

If you are prescribed a nebulizer, follow these steps carefully:

  1. Wash your hands.
  2. Open the medication cup and fill it with medication as prescribed by your health care provider.
  3. Secure the cap.
  4. Attach either a mouthpiece or mask to the end of the medication cup.
  5. Hook one end of the tubing to the medication cup and the other end to the nebulizer.
  6. If using a mouthpiece, seal lips tightly around the mouthpiece. If using a mask, place mask firmly on the face.
  7. Turn on the nebulizer. Breathe normally through the mouthpiece or mask. Continue until you no longer see the medication mist (about 10 minutes).

Care and cleaning of a nebulizer

It is very important to clean your nebulizer to prevent infections.

  • Always wash your hands prior to touching medicine.
  • After each use, remove the medication cup and rinse with warm water. Place on a paper towel and allow to air dry.
  • Once a week, clean medication cup in mild soapy water or one part vinegar and two parts water. Rinse well and place on a paper towel to air dry.
  • Replace the nebulizer cup and tubing every six months.
  • Change the filter in your nebulizer when it becomes discolored.
  • Never wash or clean the tubing because mold can grow inside.

Dry Powder Inhalers

Download the Using a Dry Power Inhaler – What You Need to Know PDF.

 

Using a Dry Powder Inhaler (DPI or Diskus®)

Dry powder inhalers (DPIs) are a type of long-term controller medicine. This type of medicine can be prescribed to help reduce the frequency of asthma symptoms. It works slowly to reduce swelling in the airways, which is an underlying cause of asthma symptoms.

Directions on how to use your dry powder inhaler:

  1. Remove all candy, food or gum from your mouth.
  2. Stand up straight.
  3. Hold the inhaler level to the floor.
  4. Open the inhaler with the mouthpiece facing you.
  5. Slide the lever away from you until you hear it click. This means the medicine has been released. Be careful not to tip the inhaler or slide the lever again; the medicine will fall out and it will be wasted.
  6. Take a deep breath in and breathe out.
  7. Place the inhaler in your mouth, seal your lips tightly around it and take a quick, deep breath in.
  8. Hold your breath for 10 seconds, and then breathe out.
  9. Rinse your mouth with water and spit water out.

Helpful tips for use:

Because this medicine is a dry powder, moisture can ruin the medicine and cause it to clump.

  • When preparing to take a dry powder inhaler, be sure not to breathe into the inhaler.
  • Do not store in the bathroom.

Metered Dose Inhalers

Download the Using a Metered Dose Inhaler – What You Need to Know PDF.

 

Metered dose inhalers (MDIs) can contain long-term controller medicine or quick-relief medicine. It is important to know which medicine your inhaler contains because the two types of medicines work on different parts of asthma.

Spacers (holding chambers)

Whenever possible, use a spacer (also known as a “holding chamber”) with your metered dose inhaler. A spacer is a plastic tube that connects to the mouthpiece of an inhaler and helps get medicine deeper into the lungs and airways.

A spacer helps direct the medicine to the airways so that each dose of medicine is more effective and less medicine is wasted.

Using a metered dose inhaler with a spacer:

  1. Remove any candy, food or gum from your mouth.
  2. Stand up straight.
  3. Remove the cap of the inhaler and attach it to the spacer. Make sure to clean out any dust or fuzz so that there is nothing inside either one.
  4. Shake the inhaler and spacer for five seconds.
  5. Take a deep breath in and breathe out slowly to empty your lungs completely.
  6. Put the spacer in your mouth and seal your lips around the mouthpiece.
  7. Press down on the inhaler and take a slow deep breath in.
  8. Hold your breath for 10 seconds and then breathe out.
  9. If using a controller medicine, rinse your mouth with water and spit water out.

Using a metered dose inhaler without a spacer:

  1. Remove any candy, food or gum from your mouth.
  2. Stand up straight.
  3. Remove the cap of the inhaler and attach it to the spacer. Make sure to clean out any dust or fuzz so that there is nothing inside either one.
  4. Shake the inhaler and spacer for five seconds.
  5. Take a deep breath in and breathe out slowly to empty your lungs completely.
  6. Place the inhaler mouthpiece inside your mouth and seal your lips tightly around the mouthpiece.
  7. Take a slow breath in, press down on the inhaler and breathe in the medicine.
  8. Hold your breath for 10 seconds and then breathe out.
  9. If using a controller medicine, rinse your mouth with water and spit water out.

COPD Medications

Download the COPD Medications PDF.

What are COPD medications used for?

Since COPD is usually progressive, regular treatment options should be ongoing unless significant side effects occur. Medication plans are introduced based on the level of COPD severity and symptoms. Your provider will prescribe medication as part of your treatment plan.

COPD treatment consists of medication and non-medication therapies. Medications are used to:

  • Prevent and control symptoms
  • Reduce the frequency and worsening of COPD symptom
  • Improve your breathing
  • Improve your ability to exercise

Medications

The following classes of medications are commonly used in treating COPD. While we have tried to provide multiple examples, the landscape of medications changes on a regular basis and we encourage you to contact your provider to determine what medication plan is best for you.

Inhaled Bronchodilators

  • Help relax tight muscles around the airways
  • Taken either on an as-needed basis for relief of symptoms or on a regular basis to prevent or reduce symptoms

Examples: Fast- or long-acting beta-2 agonists (Ventolin, ProAir), anticholinergics (Atrovent, Incruse Ellipta, Spiriva Respimat) and/or combination bronchodilator therapy (Anoro Ellipta, Stiloto Respimat)

Inhaled Corticosteroids

  • Help reduce the frequency of exacerbations (flare-ups) by reducing inflammation in the airways
  • Recommended for patients with more advanced COPD and repeated exacerbations

Examples: Inhaled corticosteroid (Arnuity® Ellipta®) and combination corticosteroidbronchodilator therapy (Breo® Ellipta®, Advair®, Symbicort®)

Oral Corticosteroids

  • Help reduce inflammation during an exacerbation (flare-up)
  • Long-term treatment not recommended

Examples: Prednisone or methylprednisolone

PDE 4 inhibitors

  • Chronic medication that reduces hospitalizations and flare ups related to COPD. Used as an add-on medication to long-acting inhalers

Examples: Roflumilast

Methylxanthines

  • Chronic medication used to help decrease shortness of breath
  • Interacts with many medications

Examples: Theophylline

 

This content is provided for informational purposes only and does not substitute for medical advice.

What is COPD?

Download the What is COPD – What You Need to Know PDF.

 

Chronic obstructive pulmonary disease (COPD) is a combination of lung damage and mucus buildup that makes it hard to breathe. It can include chronic bronchitis, emphysema or both. There is no cure for COPD, but it can be managed and the progression of the disease can be slowed.

COPD is the third leading cause of death in the U.S. Half of all people with COPD are not diagnosed. Talk to your health care provider if you have symptoms of COPD.

What are the symptoms of COPD?

In the early stages of COPD, there may be no noticeable symptoms and COPD may worsen over time. Signs and symptoms vary and may include:

  • Shortness of breath
  • Chronic cough with or without mucus
  • Wheezing
  • Chest tightness

What causes COPD?

COPD is caused by damaged lung tissue and/or mucus buildup that makes it hard for the lungs to absorb oxygen and carry it to the rest of the body. The most common cause of COPD is smoking. Long-term exposure to other lung irritants, pollution, chemical fumes or dust, may also lead to the disease.

How is COPD diagnosed?

COPD is diagnosed with a breathing test. This test will take measurement of the amount of air you are able to breathe in and out of your lungs. This test will help diagnose COPD. Once COPD is diagnosed, your healthcare provider can work with you to determine an action plan to control your COPD.

Because COPD worsens over time, it is important that it is diagnosed early to manage symptoms before they become severe. People who may need a breathing test for COPD include:

  • People who smoke or smoked in the past
  • A history of exposure to lung irritants
  • A family history of the disease
  • Are experiencing symptoms

What can you do to manage COPD?

Quitting smoking is the most important way to lessen COPD symptoms. Also, reduce your exposure to strong odors such as perfume and home cleansers, dust, fumes, gases and indoor/outdoor air pollution.

Other ways to manage COPD include:

  • Exercising
  • Taking medications
  • Oxygen therapy
  • Pulmonary rehabilitation
  • A lung transplant

Talk to a health care provider to see what’s right for you.