“Houston, We Have a Problem”: COPDF. Amos Bailey, MD Mar 2, 2021
If you’re interested in space exploration or watched the movie Apollo 13, you probably have heard the phrase “Houston, we have a problem.” Astronaut Jim Swigert reports in an understated way, that there has been an explosion on the spacecraft while on the way to the Moon. Subsequently, the world followed breathlessly, while we waited to see if NASA engineers would be able to bring them home safe. Ultimately, they do make it home, but only because they worked together as a team, trusted each other, and considered all potential solutions.
There are many parallels in the need for Palliative Care for people living with COPD and this event. For one, both left many “breathless”. In addition, people living with COPD need an interdisciplinary team approach and finally, the solution to this problem is not obvious and we need to consider all possibilities. COPD is a chronic disease that is slowly progressive. We know that only two things seem to prolong survival, stopping smoking and using oxygen therapy once people start to have hypoxia. Also, if you yourself have COPD, or have a family or friend with the disease, or have taken care of people living with it, the experience is much different and darker than the pharmaceutical company commercials for different inhalers or portable oxygen.
COPD is an orphaned disease. Many PCPs would like to refer patients with this difficult illness to a specialist while many pulmonologists see COPD as a common problem that should be cared for in the community. And so patients ping pong back and forth. What they need is a team, because the patients and their caregivers have a host of unmet physical needs and much psycho-social-spiritual distress and practical needs. Palliative Care is currently not ideally positioned to meet these unique needs and tend to patients and loved ones over a long timeline. And a patient must have a prognosis of less than 6 months to trigger their hospice insurance coverage. People often aren’t referred timely to hospice. Instead, they often have already experienced much suffering.
What is needed is for providers to take ownership. Perhaps something like the successful ECHO projects to better support PCPs to have the expertise of the pulmonologist to provide the best medical treatment and embedded advanced practice providers with specialized PC training to provide that “extra layer of support” when symptoms are first problematic.
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