Do You Really have COPD?

Congratulations, you have been categorized. First, I don’t want to minimize the impact COPD has on a person.

Just getting the diagnosis of COPD from a doctor, and then learning to live with it, are very daunting tasks.

If you got your diagnosis from a Pulmonologist, who did some sort of spirometry or Pulmonary Function Testing, then I would follow through with all the things he or she tells you to do.

On the other hand, over the years I saw and treated many “COPD patients” who did not have COPD at all. How is this possible?

Many Primary Care Physicians, [‘PCP’s’], or their PA or NP  put together a clinical picture like this:

You have been smoking for some time, you get frequent colds or URI’s, you have a cough, and complain of being short of breath. Boom! Faster than you can say “Chest X Ray”, you get handed a prescription for an Albuterol inhaler.

The truth is, you may only have allergies. You may have asthma. You may have congestive heart failure. You may have the beginnings of idiopathic pulmonary fibrosis. You might have beginning-stage COPD.

If you were diagnosed with Asthma or COPD by a PCP, I strongly recommend you see a Pulmonologist. If that is not possible, have your PCP order spirometry, pre -and -post bronchodilator. Those results will dictate the next steps.

Meanwhile, check with your insurance, especially if you discover you have been misdiagnosed.  With the advent of Electronic Medical Records, or EMR’s, a code usually goes with each diagnosis. The last thing you want is to land in the ER or the hospital, and be treated for something you don’t have.

Here’s what I mean:

Mr. Jones, 71 years old, falls and breaks a hip. He has a remote smoking history and quit 40 years ago. Although he has never been to the ER for breathing problems, his doctor gave him a prescription for Albuterol when he got pneumonia 5 years ago. His caregiver refills it every year.

Noticing the diagnosis of COPD, Mr Jones first gets a STAT Albuterol treatment before going in to surgery to fix his hip. After surgery, we will wake Mr. Jones up every 4-6 hours for a treatment. A pulmonologist might be assigned to his case. A good one, or a good Respiratory Therapist, will do some sleuthing and determine that, if Mr. Jones is not wheezing, his Chest X Ray looks normal, he has no secretions, no oxygen requirements, no Arterial Blood Gas results on file, and no Pulmonary Function tests nor 6 minute walk tests on file, that perhaps he does not need the treatments, much less the diagnosis, at all.

Another tell-tale sign that you need further workup is that the Albuterol does not relieve your shortness of breath. I’ve had many patients tell me that, when they mention this to their doctor or nurse, they are told they can use the Albuterol as many times a day as they need to. And so they do. With little relief and a lot of side effects.

If you have been diagnosed with any lung disease without at least spirometry testing, please speak up and ask to have it done. It’s simple, painless, and will tell us a lot about what’s going on inside your lungs!