The right time to see patients with lung conditions before winter

Doug Hendrie

10/05/2018 12:27:08 PM

May has arrived, and autumn’s cooler weather has come with it. This is the perfect time, Dr Kerry Hancock told newsGP, for GPs to help patients with lung conditions before winter.

Dr Hancock is concerned that people with COPD may be slow to react to symptoms as the weather turns colder, which in turns serves to intensify the issue.
Dr Hancock is concerned that people with COPD may be slow to react to symptoms as the weather turns colder, which in turns serves to intensify the issue.

RACGP Respiratory Medicine Network Chair Dr Hancock told newsGP that May – which is Lung Health Awareness Month – is the ideal time to put preventive care into action.
‘Winter is coming, and our patients with lung disease are at higher risk of deteriorating or becoming more symptomatic. So it’s about putting in place strategies to reduce risk for patients,’ she told newsGP
One key group of patients at risk are people living with chronic obstructive pulmonary disease (COPD).
The Lung Foundation Australia is calling on GPs to have the CHAT – the acronym used to make sure patients living with COPD stay well and out of hospital this winter.
CHAT stands for: Coughing, Harder to breathe, Any change in sputum, Tired more than usual.
Dr Hancock is concerned that people with COPD may be slow to react to their symptoms, which in turns serves to intensify the issue.
‘We find that COPD patients can get complacent about their increasing symptoms. They think, well, maybe tomorrow I’ll be better,’ she said. ‘But for people with COPD, who are usually older, this can be dangerous.
‘They can deteriorate relatively quickly, so they do need to take action and monitor themselves. A delay of 24 hours or more in seeking treatment for an exacerbation doubles the chance of hospital admission.
‘It’s much better if we can manage their exacerbation earlier, to prevent hospital admissions, or even deaths.’
Dr Hancock said that a key message for patients is to try to reduce exposure to all viruses, via both vaccinations and avoiding sick people.
‘It’s an awful thing to have to say to grandparents, but our message is to make sure if you have COPD that you don’t let grandkids with snotty noses crawl all over you,’ she said.
‘A virus can cause an exacerbation in their condition. We also know that after exacerbation, there’s a much-increased risk of heart attack or stroke in the next few weeks. We also know many people don’t get back to their previous lung function.
‘So it’s best to stay away from others, including the grandchildren, who have viral infections.’
Dr Hancock believes it is important to set up processes in a general practice so at-risk patients can gain rapid access to their usual GP – or another from the practice.
Given the use of domestic wood heaters in some of the colder areas of Australia can affect air quality, Dr Hancock said it was important to mention its potential effect on people with chronic lung disease.
‘We need to make sure that people avoid particulate matter – such as wood smoke – and also pollution and environmental tobacco exposure,’ she said.
May is also the right time to talk to patients at risk about immunisations for influenza and pneumococcal disease.
‘Our vaccination rate for pneumococcal disease is below 50% for over 65s, who are considered at risk of invasive pneumococcal disease [IPD] and should be vaccinated,’ Dr Hancock said. ‘We all remember to offer the flu shot, but we might not have been as diligent in offering pneumococcal vaccination.’
Some patients who are at higher risk will require this vaccination earlier than the age of 65, with some requiring a booster after five years.
Dr Hancock said lung cancer is another issue of which GPs should be aware of, even though Australia’s smoking rate has continued to decline.
‘It is still one of our top two killer cancers. It tends to be diagnosed quite late, and has a low survival rate,’ she said.
According to Dr Hancock, there is a good deal of frustration in the lung cancer treatment community about the lateness of referrals to multidisciplinary teams (MDTs).
‘If we as GPs have any suspicion of lung cancer, we should be investigating with a chest X-ray and CT scan, and then quickly off to the nearest MDT,’ she said.
In June and July, the Lung Foundation Australia will roll out a campaign calling on patients with lung conditions to see their GP over winter.
Dr Hancock said the foundation’s Health Professionals website has many useful resources to assist GPs prepare their patients for winter. The HTC (Have the CHAT) website also has many resources, such as the Have the CHAT checklist and social media images to share.

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