Therapeutic Strategies in the Management of COPD - Episode 12
Peter L. Salgo, MD: So, if we were to put together a book of practical tips, what are the practical tips? What are the takeaway messages for primary care physicians?
Frank C. Sciurba, MD, FCCP: There are 2 things. One is the incredible variability in this disease. We need to deal with the individual, in front of us, to customize their therapy. And, the other thing is, some of the most meaningful things that can influence these patients’ quality of life are not just drugs, but they’re motivating them, in the primary care setting, to exercise and lose weight and improve their symptoms.
Peter L. Salgo, MD: OK. So, exercise and lose weight. Are there any other bullet points for the primary care doctors?
Fernando J. Martinez, MD: Don’t forget smoking cessation.
James F. Donohue, MD: Involve the family. Often, the wife will be very useful in a nice way. You’ll say, to the patient, “Are you short of breath?” And, of course, they’ll say, “No.” “Are they doing anything?” The wife will say, “The only thing he does is flick the pointer at the television.” So, involve the family. The disease has tremendous impact. The success of what we’re talking about can really be helped, greatly, by a family member and the community of that individual.
Peter L. Salgo, MD: You want to engage…
James F. Donohue, MD: The community, right.
Peter L. Salgo, MD: The community and the family member. What else can a primary care physician do to help recognize these patients and get them help?
Byron Thomashow, MD: They have to ask the right questions.
Fernando J. Martinez, MD: It’s a limited number of questions, but they can be asked correctly.
Peter L. Salgo, MD: So, if I hear what you’re saying, it’s, go out and get the protocol, get those 5 questions, and either memorize them or put them on your desk so you don’t forget to ask them.
Fernando J. Martinez, MD: Also, remember the questions that Frank referred to.
Frank C. Sciurba, MD, FCCP: “How are you doing?” And, “What are you doing?”
Fernando J. Martinez, MD: And, the third one that I’d ask is, “Have you taken antibiotics or steroids in the last year?”
Byron Thomashow, MD: I agree with that, 100%.
Fernando J. Martinez, MD: You’ve got those 3 questions. You’ve got the entire algorithm in front of you for precision, personalized therapy for your COPD patient.
Peter L. Salgo, MD: Before we leave, I want to give each of you an opportunity to address our audience directly with one final thought that you may have. Dr. Donohue, why don’t you start?
James F. Donohue, MD: Be more optimistic about the treatment of this disease. We’re better at it now. We have a few more agents. Do not be nihilistic. Try to remember to keep the patient at the center of everything, and to work with them in the context of their environment.
Peter L. Salgo, MD: Dr. Martinez?
Fernando J. Martinez, MD: The key component, that you’ve heard from all of us, is the concept that you’ve got to understand to be optimistic. There really are a lot of things that you can do for these patients that will have a tremendous impact on them. Some of the concepts that Frank has advocated for, in understanding some of the complexity and using all the components that you have available, this is the group of patients to apply those to.
Peter L. Salgo, MD: Dr. Thomashow?
Byron Thomashow, MD: This is a preventable and treatable disease. We need better treatment. But what we have, together, now, the medicine, the exercise, and other things, can make a tremendous difference.
Peter L. Salgo, MD: Dr. Sciurba?
Frank C. Sciurba, MD, FCCP: You can make a difference in these patients. Just pay attention to all of the things that we’ve been saying. Motivate your patients and advocate for these therapies. Convince them. Give them the confidence that they can feel better.
Peter L. Salgo, MD: I’ll tell you what I heard from all of this, and you summarized it right here, you can make a difference. I want to thank all of you for being here. This was a terrific discussion. I want to thank you for joining us, as well. I hope you found this Peer Exchange® discussion to be useful and informative. I’m Dr. Peter Salgo, and I’ll see you next time.
Transcript edited for clarity.