Caring for COPD Patients During Winter
December 1, 2023 5 minutes read
By Jeni Miller
Navigating the care of patients who are living with chronic conditions already is challenging, but it takes an extra layer of thoughtfulness for a case manager to also consider the climate and season when making plans and facilitating decisions for patients with COPD.
Just like other extremes of temperature (i.e., humidity or high heat), cold air can make it difficult for COPD patients to breathe as icy temperatures contract vessels, restricting blood flow. This results in the lungs and heart both working much harder to send oxygen where it needs to go, taking a toll on both blood pressure and energy stores. Some COPD patients also might experience fever, swelling, confusion, and an increase in coughing fits.
Teri Cole, RN, care manager for the pulmonary inpatient care management unit for Maine Health, cares for hospitalized COPD patients. Cole was part of a COPD committee that consisted of a pulmonologist, pharmacist, and others to better manage COPD clientele.
Cole suggests case managers ask pointed questions of their COPD patients to get a full and accurate picture of their home and financial situation, discover the likelihood of the patient completing follow-up appointments, and uncover any other barriers that might prevent patients from receiving the care they need throughout the winter months and beyond.
Addressing Affordability
“Sometimes, patients will not tell you if they can’t afford their inhalers, but it’s important to pick up on those cues,” Cole says. “It’s often not noncompliance that poses a problem for patients or keeps them from getting care — it’s unaffordability, especially around the holidays when they feel they need to save money for gifts or gatherings.”
To pick up on those cues, ask specific questions about what it is like for the patient to obtain and use their inhalers. “I’ve been asking more directly now than I did in the past. That way, you get honest answers,” Cole explains. “With one patient, he simply said that he and his wife were on a fixed income of $650 per month and just couldn’t afford to buy a $300 inhaler each month. That was an honest thing that person disclosed, and it meant that the pulmonologist was able to come up with a different medical management plan that would be more affordable.”
For this patient, it was a combination of nebulizer treatments that proved to be more financially manageable and made it more likely the patient would care for his COPD in a consistent, sustainable way.
“It was maybe less convenient for him, but by working together with the provider and insurance, we were able to make it work in a way that he could afford,” Cole says.
It also can be helpful for case managers to stay abreast of pricing and costs of inhalers and other treatments, as well as where it might be best for patients to fill those prescriptions that will cause the least strain — both financially and physically.
“Case managers will want to take the time to learn about where their patients get their medications filled, or whether they do mail order,” Cole suggests.
It is a reality that patients with COPD might be less likely to go out — especially when the weather is extremely cold or hot — to pick up their medications from the local pharmacy.
“If they are short of breath, they may be more tempted to cut corners or may not be feeling well enough to go out,” Cole says. “In these situations, I recommend that patients use a mail-order pharmacy so that they can have that service provided for them and don’t have to go out for a medication or refill when they’re out of breath.”
Cole also encourages patients to visit the hospital’s pharmacy before discharge to fill their prescriptions. This way, case managers can be certain the medication is in their hands before they leave. That also gives the patient and case manager an opportunity to troubleshoot any cost issues before discharge.
Discussing any concerns about inhaler costs is an effective way to discourage the patient from only using it sparingly or skipping a dose to promote the longevity of the medication. Helping patients understand the medication will not work as effectively that way may help prevent a future hospitalization.
Encouraging patients to keep all their follow-up appointments and remain consistent with their provider’s treatment plan is crucial, Cole adds.
Education First
One of the biggest hurdles when managing COPD care is education.
“Education is a team effort between the nursing staff and providers. A lot of it centers on education about quitting smoking,” Cole notes. “It can be especially challenging to offer help for those who want to still smoke and have home oxygen as part of their COPD treatment. Unfortunately, some patients do come in with burns from doing both.”
Helping patients plan for managing stress and coping with difficulties can help promote smoking cessation, especially around the holidays, which tend to be high-stress times as people navigate family relationships, strained finances, and a busier schedule.
During this time, it is important for patients to meet with their providers on schedule. “Even asking about how they get to their appointments, whether they get rides with family or friends — all of that will help clarify whether someone might miss appointments with their providers,” Cole notes. “Naturally, people don’t want to inconvenience others, and they have a tendency to not want to be a burden, so case managers should find out who a person’s support system is and who helps to aid in their health and wellness.”
Speaking of wellness, general education for COPD patients will focus on how to stay as healthy as possible living with their diagnosis, especially with a dual diagnosis of COPD and heart failure.
“Both of these can affect breathing, so telehealth services can help people with taking vital signs, using inhalers, and taking oxygen saturation more frequently,” Cole says. “If they are willing to do telehealth or home health services, make a plan to share video tutorials and other resources that can help with ongoing COPD education. For example, our respiratory team took the lead on education on inhaler use, and our Maine Medical website hosts education tools and online classes to help with people with COPD.”
Maine Medical also offers a Living Well with COPD booklet that is given to patients for education and discusses how to identify early flare-ups and the importance of seeking treatment earlier rather than later.
A final note for case managers who are serving patients with COPD is to be cognizant of Medicaid and private payer rules for reimbursement.
“We found that inpatient pulmonary rehab did not get paid for by Medicare, Medicaid, and private payer sources,” Cole says. “For the respiratory piece to be covered, it had to be an outpatient program or coupled with occupational therapy or physician therapy. In other words, it had to be paid for in addition to the other services.”
Navigating the care of patients who are living with chronic conditions already is challenging, but it takes an extra layer of thoughtfulness for a case manager to also consider the climate and season when making plans and facilitating decisions for patients with COPD.
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