What Doctors Should Evaluate if COPD Symptoms Worsen
If your loved one with COPD is having worse symptoms, a prompt in-person medical evaluation is probably warranted, especially if the symptoms don't improve with use of a short-acting inhaler.
The goal of the medical evaluation in this case is:
To determine whether the person is having a COPD exacerbation, or flare.
If so, to figure out what might be the cause.
To check for other common causes of cough and shortness of breath.
To determine if admission to the hospital is needed.
An urgent-care visit will include documenting a history of the symptoms as well as having a basic physical. A thorough medical evaluation should cover the following key points. Note: The doctor may legitimately decide that some tests aren't necessary for your loved one's case, but if anything is overlooked, feel free to ask why.
Key parts of the evaluation
A check of vital signs, including blood pressure, pulse, temperature, oxygen saturation, and respiratory rate
Why: Vital signs help the doctor figure out what's causing symptoms and help identify particularly sick people who may need hospital admission. Note that temperature, oxygen saturation, and respiratory rate may not be routinely checked in a primary care office if the visit has been booked for routine follow-up care.
What can be done: Abnormal vital signs usually indicate a need for some kind of additional testing. Which tests are ordered will depend on the specifics of the symptoms, as well as physical findings observed by the doctor. If the vital signs are highly abnormal, the doctor may recommend transfer to the emergency room or hospital admission.
Listening to heart and lung sounds using a stethoscope
Why: Abnormal lung and/or heart sounds can help the doctor determine if the shortness of breath is due to COPD versus another problem, such as pneumonia or heart failure.
What can be done: The doctor may recommend further testing, such as a chest X-ray. Note that pulmonary function tests (PFTs) are not usually used as part of an urgent evaluation of shortness of breath, although they're essential to proper diagnosis and staging of COPD.
A check for leg swelling
Why: New or worse leg swelling can be a sign of heart failure, a clot in the leg, or acute kidney failure, all of which can be deeply concerning in a person with COPD.
What can be done: If your loved one has new or worse swelling in the shins or feet, ask the doctor to explain his or her plan for addressing this. Depending on the circumstance, the doctor may recommend further testing or may suggest a trial of medication to reduce swelling.
Why: Symptoms of COPD and diseases such as heart failure often get worse when a person doesn't take his or her medication every day as directed. The doctor should review what medications have been prescribed as well as understand how accurately your loved one has been taking the medications. Note: Busy doctors sometimes don't get around to reviewing medications unless caregivers specifically ask that this be done.
What can be done: Bring all medications and inhalers in a bag to the visit, regardless of which doctor prescribed them. Be prepared to show the doctor which medications are actually being taken, and how. At the end of the visit, be sure you understand any changes in medication that have been recommended. A worsening of COPD symptoms often requires at least a temporary course of extra medication.
A plan for follow-up
Why: Every urgent-care visit should end with a clear plan for follow-up. In particular, you'll want to know what signs indicate that your loved one should return to the doctor for further evaluation or for medication adjustment.
What can be done: Depending on your loved one's case, the doctor may recommend that you schedule a visit within several days to confirm that your loved one is better. Or the doctor may instruct you to call for a return visit if the symptoms persist.
Additional tests that may be ordered
These tests may or may not be ordered, depending on the specifics of your loved one's case.
Why: Blood work can help rule out certain conditions that cause shortness of breath, such as anemia (low red blood cell count), acute kidney failure, and heart failure.
What can be done: Ask the doctor to explain any abnormalities found in blood work results, whether they might be related to COPD, and what the plan is for addressing them.
Why: An electrocardiogram (ECG or EKG) can be used to check for certain cardiac causes of shortness of breath, such as coronary ischemia (low blood flow to the heart muscle) or atrial fibrillation (a type of irregular heartbeat). Getting an ECG involves using electrodes taped to the skin on the chest to measure the electrical activity within the heart. This information creates a tracing, which can be printed on paper or viewed on a monitor.
What can be done: Ask the doctor to explain any abnormalities found in ECG results, whether they might be related to the worsened COPD symptoms, and what the plan is for addressing them.
Why: A chest X-ray can help confirm pneumonia and can help check for some causes of shortness of breath and/or cough.
What can be done: Ask the doctor to explain any abnormalities found in chest X-ray results, whether they might be related to the worsened COPD symptoms, and what the plan is for addressing them.