Patients with stable lung disease should be seen at least once a year by their primary health care provider. The first visit can be the starting point for stopping lung disease. It is a time for making sure everything that can be done is done. Often, an individual with COPD is followed by a primary care doctor for “day-to-day” problems. But a lung specialist may be seen if unusual problems arise or if you are not responding to treatments.
Learning About You
It is important for your health care provider to get a variety of baseline information. “Baseline” means information that can be compared with futureinformation to decide if treatments are working or if changes have occurred. This info will include a medical history, physical exam and testing (see Section A, Chapter 1). Much of this information may
have been collected before the diagnosis of COPD was made. It may take more than one visit to gather and review all of this information.
Before your doctor visits, you may find it helpful to complete certain worksheets located in Appendix C. After doing this, you will have much of the information your doctor will need. Completing the worksheets can also remind you of questions you want to ask your doctor. It is easy to forget questions in the doctor’s office. Some people find it helpful to bring a spouse, family member or close friend with them. Having an extra set of eyes and ears during your visit can be helpful. (Your visitor may not be able to join you for all parts of your
doctor’s visit.) Some doctors allow you to record your visit with a tape recorder so you can review it later. If you want to do this, check with your doctor’s office first.
With rapidly changing health insurance, frequent changes in work and huge paperwork requirements, it is important to remember that your medical records belong to YOU. Always ask for copies of test results. Or, if you prefer, keep copies of your entire medical record. This will help you understand your care and direct any questions you have. It will also help a new health care provider quickly learn about your medical condition. Many patients keep a journal of their medical visits, medicines and illnesses. If you (or someone you know) is computer savvy, consider scanning your records to a PDF file. You can then copy them to a USB memory stick. The more information you and your health care provider have about your condition, the better your care will be.
During the interview portion of this first visit, the doctor will gather specific historical information. This information will fall into several categories. These are chief complaint, history of present illness and past medical history. Other categories are family history, social history and review of body systems.
First, your health care provider will want to know the reason you have come in for this visit, or your “chief complaint.” He/she will also want to know the current status of your lung problem. You may be there simply because the doctor told you to “come back in three months.” Or you may have a specific problem, such as a lung infection, that brought you in.
Many doctor’s offices will ask you to complete a medical history form prior to seeing the doctor. This form may look like the sample worksheets we have provided at the back of this Guide. The form may ask you to describe your current medical status and any medicines you are taking. You will be asked to list any changes that have taken place
since your last visit. It is important to let your health care provider know about any allergies you have, especially to medicines. As a COPD patient, certain parts of your medical history are unique and may take on added importance.
Your Current Lung Disease Symptoms
It is important to review your current symptoms of lung disease. For example, your health care provider will want to know how often you cough. They will want to know if your cough is “productive.” This means do you often cough-up mucus or phlegm? If you have a productive cough, it is also important to describe your mucus. What is its texture and color? Is it thick or thin? Foamy or watery? Clear, yellow, green, brown or bloody?
Here are some examples of issues you should be prepared to discuss:
- Do you have wheezing in your chest?
- How often are your lung infections? What symptoms alert you to a lung infection?
- Do you get breathless? If so, when does it occur? All the time or only when active?
- Do you use medicines, such as an inhaler? Does this improve your breathing?
- Do you have side-effects from your medicines? Side-effects can include shakiness, rapid irregular heart beats, muscle cramps or problems sleeping.
- How far can you walk or climb the stairs before you have trouble breathing?
- How long does it take you to recover?
- Do you use oxygen?
- Do you have sleep problems? These may include insomnia, frequent awakenings, snoring or stopping breathing for periods during sleep.
- Have you noticed that you are more short of breath at higher altitudes? This might include when you are visiting the mountains or traveling by airplane.
- Do you have other health problems or concerns?
You may want to take this chance to discuss with your doctor other concerns you have. These might include issues related to alcohol intake, sexual function, non-prescription or illicit drug use or other personal questions. Your doctor may ask many other questions of you as well. These questions will help you and your doctor understand your total medical condition and the lifestyle issues that affect your health.
Your History with Cigarettes
Another important area is your smoking history. Your health care provider will need to know the age you started smoking and how many cigarettes you smoked per day. They will also ask if you are still smoking, and, if not, the date you stopped. It is important to note the type of tobacco you smoked (filtered or unfiltered cigarettes, cigars, pipe, other).
Your health care provider will review each system of your body with you to be sure you haven’t forgotten anything. Heart problems can often appear to be lung problems. And lung problems may seem to be heart problems. For that reason, a careful history of your heart health is taken. Your health care provider will want to know if you have had certain types of heart disease. They are particularly interested in those types that can cause fluid in the lungs or reduce your ability to exercise.
Past Medical History
You and your health care provider will have detailed discussions of your past medical history. Your health care provider will want to know all of the surgeries you have had. For each, you will need to describe when it was, how you handled the surgery and if the problem was corrected. A complete review of all past medical problems will help your health care provider decide how these affected your lung disease. It is also important to list all medicines you are currently taking, as well as those recently stopped. Current medicines could
interact with medicines prescribed for your lung disease.
Information About Your Family
It is important for your health care provider to get your detailed family history. This is a great tool for determining any risk factors that may affect your treatment plan. As described in Section A, Chapter 1, there is a growing knowledge that genes you inherit from your parents may increase your risk of developing COPD.
Your Medicines and the Shots You Have Had
As discussed above, your doctor will want to know about the medicines you are currently taking. You should make a list of all of your medicines. You should include why each was originally prescribed and when you started taking each. You will also want to discuss whether you feel your medicines are working and if you are having any side effects. Don’t forget to include any over-the-counter or alternative medicines you are taking.
You should tell your doctor about medicine, food or environmental allergies you have had in the past. Bring a list of all the shots you have had. This should include your most recent flu, pneumonia and hepatitis shots.
After completing the interview and reviewing your medical history, your health care provider will continue to gather information about you. They will perform a physical exam and order lab and diagnostic tests.