Latest news with #pulmonologist
Medscape
11 hours ago
- Health
- Medscape
PCP Toolkit for Treating Patients With Respiratory Diseases
Primary care physicians (PCPs) regularly encounter respiratory issues, from the common cold to asthma, chronic obstructive pulmonary disease ( COPD), and more. These conditions can, at times, be diagnosed fairly quickly and easily. But sometimes, ubiquitous symptoms can make differentiating diagnoses difficult. Lung diseases can range from very minor to critical, so you don't want to waste any time in the diagnostic process. It's important, then, to know what tools PCPs have at hand and how to best apply them. This is especially true as many lung diseases also have comorbidities. 'Patients with COPD often also have high blood pressure, high cholesterol, and left-sided heart disease,' said Jeffrey Marshall, MD, pulmonologist at University of Maryland Baltimore Washington Medical Center in Glen Burnie, Maryland. It's also common for patients with respiratory diseases to experience concomitant mental health struggles, according to Marshall. For instance, high rates of anxiety are often found in patients with advanced lung disease. 'All these comorbid conditions can both exacerbate the patient's underlying pulmonary disease or be confused as an exacerbation of that pulmonary disease,' he said. Respiratory complaints — like difficulty breathing and chest pain — are among the most common reasons patients visit the emergency room. While these complaints may fall within respiratory illnesses, there are often other explanations for a patient's symptoms. Learning to discern these differences can be an important skill set as a PCP. That said, it's also important to know when to refer to a specialist. 'Early recognition and timely referral can significantly improve patient outcomes,' said Tejaswini Kulkarni, MD, associate professor of medicine and director of the Interstitial Lung Disease Program at The University of Alabama at Birmingham. Here's what you need to know to treat and guide your patients presenting with respiratory issues. PCP Toolkit The first step to having a handle on respiratory issues with your patients is taking a comprehensive medical history. For patients who have been already diagnosed with a respiratory condition, 'it's important to reinforce proper disease management and medication adherence,' said Marshall. 'Exposures, triggers, prior personal history, and a detailed family history are all important components of understanding a patient's pulmonary condition.' Tobacco use is a primary example of this — patients who currently smoke or have smoked in the past are going to be more susceptible to respiratory conditions of all kinds. 'Though cigarette use has declined in most places across the country, tobacco use still has a significant impact on our nation's health,' said Marshall. 'Tobacco use contributes to many diseases, including asthma, COPD, heart disease, and, of course, cancer. Current and former smokers are also at a significantly increased risk of infections, namely the development of pneumonia.' In addition, patients with a history of smoking are more likely to be hospitalized and die from pneumonia, he said. Physicians should also consider their patients' work history, hobbies, and current occupation. Patients who work in certain occupations, like construction, for instance, may have exposure to harmful substances, like asbestos or certain paints. Chronic exposure may lead to complications and can be a good starting point for diagnosis. Even living in an area with high pollution and poor air quality can be a contributing factor. Patients will present with both acute and chronic symptoms, ranging from cough to shortness of breath, exercise-induced asthma, allergies, and sleep apnea. After taking a comprehensive history, physicians can utilize a variety of tools for further diagnosis — one of which could include pulse oximetry. 'Though patients typically present with symptoms prior to ever becoming hypoxemic, it may be helpful to get a walking pulse oximetry to understand the degree of changes in SpO2 and heart rate with exertion,' said Marshall. 'Simply walking a patient with a pulse oximeter can provide helpful information regarding exercise tolerance and whether that patient needs oxygen.' Physicians might also want to try a handheld spirometer, which is simple to use and provides a good deal of information regarding patients' pulmonary and respiratory health. 'Spirometers can provide you with a basic set of numbers right in the office,' said Orlando Ruiz-Rodriguez, MD, a pulmonologist at Orlando Health in Orlando, Florida. A basic stethoscope can also help in diagnosing pulmonary issues. 'Listening to lungs is part of the standard of care,' said Ruiz-Rodriguez. 'Make sure there are no abnormal sounds, like wheezing, crackling, or decreased breathing. Today's generation of stethoscopes are electronic and a much-improved tool at the primary care level.' There are other tests PCPs can explore before deciding it's time to seek out a specialist. 'To expedite workup and management of patients with lung diseases, pulmonologists typically prefer certain baseline tests before a referral,' said Kulkarni. 'These commonly include pulmonary function tests to assess airflow obstruction or restriction, chest imaging (chest x-ray or high-resolution CT if interstitial lung disease is suspected), and basic lab work such as CBC [complete blood count], CMP [comprehensive metabolic panel], and BNP [B-type natriuretic peptide test].' To help reduce diagnostic delays and improve patient outcomes, it's best to move with caution when considering a pulmonary fibrosis diagnosis, said Kulkarni. Pulmonary fibrosis is often challenging to diagnose because clinical presentation mimics common conditions like coronary artery disease and COPD, 'but it has worse clinical outcomes with delays in treatment,' she said. Beyond diagnostics, one consideration to keep in your toolkit, said Marshall, is vaccines. 'Patients with underlying respiratory or pulmonary conditions are at a higher risk of developing and becoming sick from respiratory illnesses,' he said. 'We now have several extraordinary vaccines available to our patients to help reduce the burden of infectious respiratory disease.' When to Refer While PCPs can treat respiratory issues in office to the best of their ability, there are times when referring to a pulmonologist is essential. 'Your local neighborhood pulmonologist is your friend,' said Marshall. 'Referrals to a pulmonologist should be considered whenever there is diagnostic uncertainty, when initial therapeutics are not working, or when more complex interventions or therapeutics are necessary in the workup and management of your patient.' A few common reasons to refer to a pulmonologist include treating or diagnosing unremitting cough or chronic refractory, he said. There are certain times when immediate referral is appropriate, according to Kulkarni. These include rapidly progressive dyspnea, hypoxia, hypercapnia, hemoptysis, suspected lung cancer, and large pleural effusions. For cases of symptom progression, she recommends referring with chronic coughs lasting over 8 weeks, unexplained or worsening dyspnea, frequent asthma or COPD exacerbations despite treatment, recurrent pneumonia, and signs of pulmonary hypertension. Referring should not be considered a last resort, either, said Ruiz-Rodriguez. 'Some primary care doctors want to do as much as possible before referring,' he said. 'But know the limitations of what you have available to you. If your patient has symptoms, abnormal test results, or even a complicated medical history, send them to us. Even sleep apnea with a complicated history is a cue to move on to a specialist.'
Medscape
2 days ago
- Health
- Medscape
Tackling ‘Treatable Traits' in Obstructive Lung Disease
If only managing a patient with an obstructive lung disease — like asthma or chronic obstructive pulmonary disease (COPD) — were as easy as writing a prescription. As it stands now, physicians also have to worry about whether their patients are using their inhalers correctly, or even taking their medications at all, as well as numerous other factors that can complicate their prognosis. 'Every patient is different,' said Amy Attaway, MD, a pulmonologist with Cleveland Clinic in Cleveland. 'Every patient has these barriers that are impacting their COPD or asthma that is making it difficult to treat them optimally.' What Are Treatable Traits? Amy Attaway, MD A recent study published in the International Journal of Chronic Obstructive Pulmonary Disease described how many primary care patients exhibit various combinations of treatable traits, thus requiring personalized attention to help get their symptoms under control. Attaway said she likes the treatable trait concept, which includes assessing each patient and developing personalized approaches for their specific issues. 'If you don't define a problem, it's really hard to treat it,' she said. 'This highlights that every patient is different, and you have to personalize their therapy.' The study authors specifically looked at the following traits in people with asthma, COPD, or a combination of both: Insufficient inhaler technique Poor adherence to lung medication Type 2 eosinophilic inflammation Current smoking Obesity Physical activity Reversible airflow limitation Anxiety and/or depression All these treatable traits can pose challenges by themselves — potential combinations only drive up the complexity. Primary care physicians are already addressing many of the treatable traits, such as obesity and physical activity, as well as anxiety and depression. But there are still ongoing challenges. That's particularly true for most patients with COPD because the condition often exists in tandem with other comorbidities that must be managed, according to Wilson Pace, MD, a family medicine physician and professor emeritus in family medicine at the University of Colorado Anschutz Medical Campus, Aurora, Colorado. Then, there's the time element — or the lack of time — as the case may be. 'That's the great burden of a primary care physician,' said Stephanie LaBedz, MD, a pulmonologist with UI Health in Chicago. Stephanie LaBedz, MD Having a checklist of treatable traits can help physicians keep track of all the factors that may be influencing their patients, said Attaway. But clinicians may not have the time in a single visit to address all of them. Even a short inhaler technique training session or refresher can take some time. 'If you see multiple patients a day, that 5 minutes really adds up,' said Edward Len, MD, a pulmonologist with the Mid-Atlantic Permanente Medical Group in Largo, Maryland. Social determinants of health that affect medication adherence may also need addressing, said Len. For example, physicians may need to determine if their patients have transportation to and from a pharmacy to pick up medications, as well as money for the copays. Medication Use Challenges Some treatable traits may be harder than others to manage from a primary care setting. Each type of inhaler requires a specific inhalation technique , and some patients must use multiple different types of inhaled medications to manage their obstructive lung disease — which requires them to master different techniques. Edward Len, MD Additionally, age and cognitive function can also affect a patient's ability to use their inhaled medications correctly, according to research. 'They don't recognize that they don't have optimal inhaler technique,' LaBedz said. 'They think they're doing it correctly.' Perhaps not surprisingly, perfect inhalation technique by patients is rare, which means that patients may not be receiving as much benefit from their inhaled medication as they should. And that's assuming that they're diligent about trying to use their medications. Theaforementioned study cited people forgetting to use their medication as one of its treatable traits. According to LaBedz, medication adherence among patients with COPD is below 50%. In fact, some research estimates that adherence among patients with obstructive lung disease is between 10% and 40%, even though they're more likely to experience exacerbations that lead to hospitalization when they're not properly taking their meds. 'If they're not using the inhaler, it's not going to work,' said Len. LaBedz said she would not expect a primary care provider to handle insufficient inhaler technique — at least not all by themselves. As a pulmonary specialist, she can offer an in-depth assessment of inhaler technique education and training. However, while primary care physicians may not always have time, primary care practices can designate and train a nurse to educate patients on proper inhalation technique, Pace suggested. 'Well-running primary care practices try to make sure that everyone is working at the peak of their license,' he said. Having in-house staff to work with patients on inhaler technique could also reduce the burden on the patient since they wouldn't have to make an additional visit elsewhere to receive training, Pace said. It may also reduce the likelihood that a patient would be a no-show at their follow-up visit, which research suggests is a common phenomenon among patients who receive a referral from a primary care physician to see a specialist. Getting Patients on Board One challenge not included in the above study's treatable traits list: Patient motivation. Sometimes, physicians may find themselves having to persuade patients to make changes in their behavior, and that can be its own challenge. 'If they don't care enough about it, getting them to change behavior is tough,' said Pace. Even similar motivations can require different approaches. What works for one patient may not be as effective for another. 'You always have to come to the middle with patients,' said Geoffrey Chupp, MD, a professor of medicine in pulmonary, critical care and sleep medicine at the Yale School of Medicine, New Haven, Connecticut. 'Everybody has their own journey. Some people are more adept at these things than others. You have to find what works for any core individual. You have to reinforce it and give them positive feedback.'
National Post
04-06-2025
- Health
- National Post
Canadian wildfire smoke causes 'very unhealthy' conditions in American Midwest and reaches Europe
Article content Hennepin Healthcare, the main emergency hospital in Minneapolis, has seen a slight increase in visits by patients with respiratory symptoms aggravated by the dirty air. Article content Dr. Rachel Strykowski, a pulmonologist, said there is usually a bit of a delay before patients come in, which is unfortunate because the sooner those patients contact their doctors, the better the outcome. Typical symptoms, she said, include 'increase in shortness of breath, wheezing, maybe coughing a bit more, and flares of their underlying disease, and that's usually COPD and asthma.' Article content What happens, Strykowski said, is that the fine particulate matter from the wildfire smoke triggers more inflammation in patients' airways, aggravating their underlying medical conditions. Article content Strykowski noted that this is usually a time those patients can go outside and enjoy the summer weather because there are fewer triggers, so the current ones forcing them to stay inside can feel 'quite isolating.' Article content People can protect themselves by staying indoors or by wearing N95 masks, she said. Strykowski added that they must be N95s because the cloth masks many people used during the COVID-19 pandemic don't provide enough filtration. Article content Canada is having another bad wildfire season, and more than 27,000 people in three provinces have been forced to evacuate. Most of the smoke reaching the American Midwest has been coming from fires northwest of the provincial capital of Winnipeg in Manitoba. Article content Winnipeg hotels opened Monday to evacuees. More than 17,000 Manitoba residents have been displaced since last week, including 5,000 residents of the community of Flin Flon, nearly 400 miles (645 kilometers) northwest of Winnipeg. In neighboring Saskatchewan, 2,500 residents of the town of La Ronge were ordered to flee Monday, on top of more than 8,000 in the province who had been evacuated earlier. Article content Article content In Saskatoon, where the premiers of Canada's provinces and the country's prime minister met Monday, Saskatchewan Premier Scott Moe said all of Canada has come together to help the Prairie provinces. Article content Article content Two people were killed by a wildfire in mid-May in Lac du Bonnet, northeast of Winnipeg. Article content Canada's worst-ever wildfire season was in 2023. It choked much of North America with dangerous smoke for months. Article content The smoke reaches Europe Article content Canada's wildfires are so large and intense that the smoke is even reaching Europe, where it is causing hazy skies but isn't expected to affect surface-air quality, according the European climate service Copernicus. Article content The first high-altitude plume reached Greece and the eastern Mediterranean just over two weeks ago, with a much larger plume crossing the Atlantic within the past week and more expected in coming days, according to Copernicus. Article content 'That's really an indicator of how intense these fires are, that they can deliver smoke,' high enough that they can be carried so far on jet streams, said Mark Parrington, senior scientist at the service. Article content The fires also are putting out significant levels of carbon pollution — an estimated 56 megatonnes through Monday, second only to 2023, according to Copernicus. Article content
