Patients aren’t always so happy to see Randy Sweet, BS, RRT, a respiratory therapist in the Mercy Washington COPD Education Center. At least, not initially.
Many of them show up reluctantly. One even came right out and told him she was only there as a favor to her pulmonologist, Dr. Umer Siddiqui.
An hour later, though, that same patient was apologizing both to Sweet and Dr. Siddiqui for her attitude.
“I’ve been dreading this appointment for three weeks; I was wrong!” she said.
Sweet has dozens of similar responses from patients and doctors remarking on how much Sweet has helped improve their or their patient’s quality of life. One primary care physician has even referred to the program as “a patient satisfaction home run.”
Located inside the sleep lab on the second floor of the Mercy Medical Building South at 901 Patients First Drive, the COPD Education Center is basically an office where Sweet meets one-on-one with respiratory patients to help them understand things like how they should be taking their medications, what their triggers are and when they should call the doctor for more help.
The center opened a year ago, and since then, more than 400 patients have been through the program, referred by their pulmonologist, primary care doctor, hospitalist, emergency department provider or advanced practitioner.
There is no charge for patients to visit the center, but a referral is necessary, Sweet explained, so he can access a person’s medical records to know how best to help them.
Nearly all of the patients who have been seen at the education center have changed the way they manage their COPD, and that has resulted in a decrease in the re-hospitalization rate for COPD patients.
“Now their care is better, their pulmonary function is better, and they aren’t ending up in the hospital as often,” said Sweet. “The re-admission rate is being addressed with this. It’s very positive.”
A One-Hour Conversation
COPD, which stands for Chronic Obstructive Pulmonary Disease, is a progressive lung disease that makes it hard for people to breathe. Sweet described it as a combination of emphysema and bronchitis.
The majority of COPD patients, around 80 percent nationally, have COPD as a result of smoking, he said, but there are other causes as well, including secondhand smoke and genetic issues.
The age range of patients he has seen at the education center so far has been 36 to 98. Some of the patients, despite their COPD diagnosis, continue to smoke, he said, although he does talk with them about how much it would help their condition if they could stop.
Sweet, who has been a respiratory therapist since 1972 and with Mercy for almost 20 years, said he begins all of his meetings with patients by asking them what concerns they have about their breathing.
“I say, ‘I know your doctor sent you here. You are on some respiratory medications to treat COPD. You have some concerns and questions. What’s on your mind?’ ” said Sweet. “I get them engaged in the conversation and get their concerns resolved. We get the conversation started, then I plug in more info easily.”
He talks with them about why getting immunizations for the flu and pneumonia are so critical — because coming down with either of those conditions will only worsen their COPD and potentially land them in the hospital.
He teaches them the importance of knowing their triggers, or those things that will cause them respiratory distress. These can be pet hair and dander, warm or cold air, the smell of perfume or a household cleaner.
But the most important thing Sweet stresses to patients is calling their doctor whenever they come down with a sore throat, cough or cold, wheezing . . . Even though those conditions might feel too minor to bother the doctor, they can turn serious fairly quickly for someone with COPD, Sweet explained.
That’s something people who’ve had COPD for a while understand, but something that newly diagnosed patients don’t realize yet.
“But it will end up in their lungs every time, so I tell them, when your pulmonologist says, ‘If you have any problems, give me a call,’ that includes a cold. He’s not saying, ‘If you have any catastrophes, let me know,’ ” said Sweet. “Problems are something you can solve. Early intervention is the way you stop pneumonia or the flu, which only makes your COPD worse, so you’ve got to get on that. That’s what we’re trying to address.”
Sweet also talks with patients about the importance of exercise.
“You have to move, do what you can,” he said, noting that can be as simple as walking until you are winded, but then resting until you are recovered and then starting again.
Knowing How, What, When, Why of Medications
Before the clinic opened, Sweet had no idea that there are respiratory patients who don’t know the best way to use or take their medications, but through the education center, he’s come to realize that is a major stumbling block for many patients.
He understands why. Treating COPD isn’t about just swallowing pills at a certain time every day.
“Respiratory medicine is in stages. That’s why I have this,” said Sweet, holding up a “spacer” or a tool for using a metered dose inhaler. “If they don’t have one, we give them one and show them how to use it.
“You get about two-thirds more medicine when you use a spacer,” he said. “Otherwise (the medicine) just hits the back of your throat and goes down your gullet, and that’s the first thing they say, ‘I felt it.’
“When they use a spacer the first time, they don’t think it’s working because they don’t feel (the medicine) hitting their throat, but I say, ‘That’s right! You’re not supposed to.’ ”
That’s because the spacer is making it easier for the medication to reach the lungs and not just end up in the mouth and throat, said Sweet.
In the office, he shows patients how to use a spacer and then provides them a detailed reference they can take home with them.
“I’m trying to get their attention on how important it is to focus on your breathing when it’s time to take your medication,” said Sweet.
“I tell them, you will take two puffs on your inhaler in the morning and two puff later. Do the same thing at night. That’s eight breaths. Do you know how many times you breathe a day? If you are breathing 20 times a minute, that’s 28,800 breaths. I’m asking you to take eight breaths so that the other 28,792 are easier.”
He also talks with them about what the direction “as needed” means and knowing what maintenance respiratory medicines do and when to take them, among other things.
Sweet presents the information, not as a lecture or a sermon, but as an educational process. “I don’t want to tell you,” he said. “I want to show you.”
And the patients appreciate that.
“We’re just having a conversation,” said Sweet. “And I tell them if the doctor changes their medication, they can come back through here and we’ll go over it again.”
The feedback Sweet has received from the doctors referring their patients to him has been positive as well. They use words like “breakthrough,” “hope” and “fantastic” to describe the change in their patients’ quality of life.
Sweet feels good knowing he’s able to make such a big difference for people.
“It’s been very positive. It’s going really well. It’s been a fantastic opportunity to help people with this,” he said.
For COPD or ‘COPD-Lite’
People who are on respiratory medications but who haven’t been given a COPD diagnosis are eligible to come to the education center as well.
“They may not have pulmonary function that’s going to show they have COPD, but they are on medications. I call it COPD-lite,” said Sweet. “The thing is, we want to keep it that way.
“There are a lot of people who don’t have official COPD who are this way. Those are the people we really need to address, people who are on respiratory medicines and have breathing problems . . . there’s no difference when you step over the line to being diagnosed with COPD. The symptoms are treated the same and we’re trying to prevent reinfection, which can make COPD worse.”
People who fall into that category of “COPD-lite” can call the education center (636-390-1771) or come to the desk for assistance in making an appointment.
“Tell us your doctor’s name, so we call your doctor, have the order put in,” said Sweet. “And if we are available right then, we can see them right away.”
Sweet understands too that not everybody believes they need his help. But the past year has shown that they probably do.
“I have found is anyone who is on any kind of respiratory medicine, there is a 99 percent chance that I can help them,” he remarked.
For more information on the center or the referral process, people should call 636-390-1771 or visit mercy.net/COPDEdu.