10 replies to this topic

[Dee]

From the COPD DIGEST


The question is: Should patients with COPD be given antibiotics to keep on-hand to use at their discretion?.
I believe that only certain patients with COPD should be given antibiotics so they can self-medicate in case of an infectious exacerbation of their COPD.
The goals of patient initiated antibiotic therapy include shortening the time between diagnosis and treatment, providing treatment as conveniently as possible and minimizing the obstacles to the delivery of urgently required care.
Pros
Although in the past it was a controversial subject, a consensus has been recently built in support of the use of broad spectrum antibiotics for the treatment of exacerbations of COPD believed to be infectious. An infectious exacerbation of COPD is defined as a sudden flare up in respiratory symptoms that include increased cough and mucus volume.
These diagnostic guidelines must be differentiated from the more severe problem of pneumonia. A recent review published by The Cochrane Collaboration concluded in favor of antibiotic use in the treatment of exacerbations, saying that antibiotic therapy in this particular setting helps patients recover from COPD exacerbations.
Cons
I do not think every patient with COPD is able to self-diagnose and self-treat with antibiotics. It takes insight, motivation and decisiveness to be able to properly start a course of antibiotics. A patient should have successfully overcome at least one infectious exacerbation in collaboration with their physician prior to being a candidate for "patient controlled antibiotic therapy." Those patients who have demonstrated an ability to correctly recognize an exacerbation and differentiate an exacerbation from other problems should be considered potential candidates.
Patients who suffer from COPD plus other active medical problems or “co-morbidities” are not ideal candidates to be given the responsibility to start an antibiotic course. These patients will have more trouble determining if their increased respiratory symptoms are due to an exacerbation of COPD or one of their other ailments.

The Next Steps
After a sound relationship has been established between a patient with COPD and physician, it is appropriate to empower some patients so they can treat themselves with an antibiotic when necessary. A candidate patient needs to be counseled and educated about the risks and benefits of the self-initiated treatment prior to the antibiotic prescription.
The patient and physician must agree on a set of symptoms and signs that should lead the patient to initiate use of the antibiotic. In addition, an explicit agreement should be reached to ensure the patient will seek additional help if symptoms fall out of the range of what is considered an accepted exacerbation of COPD.

[Tim]

From experience, I've learned that self medication isn't always the best way to go.
My Dr gives me a Prescription for three antibiotics at a time and at the first sign
of an infection, I'm to get the first one filled and then call his office for an
appointment. This keeps me from taking the same Antibiotic all the time
and cuts the chance of my developing a resistance to the really good antibiotics
that I feel always work.

I guess what I'm trying to say is that I disagree with the practice of starting an
on hand antibiotic without following up with the Dr. We can go downhill so fast
and our Dr's should be aware when we're having problems.

Just my thoughts..

Tim

[Neva]

I keep antibiotics and prednisone on hand. My doc says he doesn't do this for every patient but says I am a well informed patient and he can trust me enough to do this. With my low lung function he wants to be to able to stay on top infections. There have been times when a antibiotice wasn't needed and I just needed prednisone. I go on the mucus that I cough up to determine which I need. I do have to call him and I always do. If it is the weekend and I go ahead and start the antibiotic or prednisone or both and call him first thing on Monday morning. Of course if it's bad or I'm not sure I page him. I have his pager number but I've only needed to page him one time. He called me back with the hour. This is why I love my doc! Not many doc's are going to offer their pager number.......
I have never been in the hospital with lung problems and I am sure this is the reason why. Also I keep an anitviral around as well in case I get the flu. I've only needed to take that once. If someone isn't really knowledgable about their lung disease I wouldn't recommend this but for a well informed patient it is the way to go.
Take Extra Good Care,
Neva

[richardjm]

Neva, you're exactly right when you refer to being a well informed patient. Obviously you're able to stand back and observe what's happening to your body and take the appropriate action based on experience and knowledge. Living in the boonies, we too have to learn to self-diagnose and medicate accordingly, which is why we ask questions and search for knowledge from this forum and other sources.

If something unusual crops up, then the procedure is to observe and note what is happening, stabilise the condition and then get in touch with the expert if it's really beyond you. That said, I know many people who are so out of touch with their own bodies that they would be incapable of any useful self observation and would call out the emergency services for heartburn. Unfortunately, until you are able to prove that you are interested in taking some responsibility for your own body, doctors do treat you as if you are totally useless and I find it interesting how your relationship with the doctor becomes more of a discussion between intelligent adults once you have disproved that "useless" tag.

[richardjm]

I re-read Tim's post and realised that my post related rather more to my condition than to Tim's, where the selection of a specific antibiotic from the range available could be much more important, although I imagine that Tim's doctor would have indicated which antibiotic should be matched with whatever condition that manifests itself. Sorry, I did not mean to belittle anyone's relationship with their condition or doctor.

I have not yet found myself in Tim's situation and find that I am in agreement with contacting the doctor ASAP in those circumstances.

[Tim]

I'm not so much against having the antibiotics and steroids on hand as I am the practice of self medicating
without letting your Dr know what's going on. And I speak more to the newly Dx'd then to the long time patient
who's been fighting these diseases for many years. I have antibiotics available anytime I need them and my Dr has
told me in what order he wants me to start them.. We all know that we always start getting sick late Friday night
or during the weekend or a holiday when the Dr isn't available. I always have Prednisone on hand and will increase
my dosage when symptoms are indicated but still would want to notify my Dr who always has me come in.
I've found that it's much easier to fight this disease without your Dr having to play catch up.

I don't feel like I was being singled out Richard, you make some very valid points. I'm fortunate to have
such a good working relationship with my Dr but it didn't happen overnight, it's came about after years of
knowing each other.

Tim

[Neva]

Yes Tim, it does take some time. Richard is right about some people calling heartburn an emergency and that's why it takes time to get to this point with your doc. Doc's listen to the kinds of questions patients ask and also notice if no questions are even being asked. Once or twice I have even educated my doc about something concerning Alpha-1. He trusts that I know my body and that I can act upon things in an appropriate manner. He's been part of my education and is always good to explain everything. I have been seeing my doc for 10 years and we have a good "working" relationship. We chat about so much more than medical issues when I go in to see him. I wouldn't trade him for the world. I feel blessed and lucky.

[jarity]

Just had a 3 week bout of infections. am just about over it now. self medication played a part till my pulmo got back from vacation. came here to do a research today on this issue and found this discussion. i also have a long standing relationship with my pulmo. he does not have a office with a desk per se but pulls up a chair and sits a across from you and starts listening!!!!! anyway i found this discussion exceptionally helpful. members have so much accumulated knowledge.

[Neva]

Jarity you have a good doc it sounds like. My doc does the same thing. He tells me that I know my body much better than he does so he listens.....
He held my hand me whenever we talked about transplant evaluation and hugged me and told me everything would be okay. He laughed and did a happy dance when they kicked me out of the transplant program because I improved and wasn't conisidered sick enough. He is priceless.
It's good to see you posting. Come back and join us when you can.
Take Extra Good Care,
Neva

[Dee]

You have all made some very good points. I came across this article today and thought it was interesting.


Self-Treatment Results In Lower Overall Health Care Costs For COPD Sufferers, Study Suggests


ScienceDaily (May 17, 2009) — Individuals suffering from chronic obstructive pulmonary disorder (COPD) can experience significant savings in healthcare costs by employing a self-treatment program with the judicious use of medications, according to the results of a new study. The self-treatment program achieves these savings by reducing the duration of flare-ups.

Dutch researchers presented their findings on May 17, at the American Thoracic Society's 105th International Conference in San Diego.

"The course of COPD is characterized by episodes of acute deteriorations in respiratory health, termed 'exacerbations,'" said lead author Tanja Effing, Ph.D., a researcher with the Department of Pulmonary Disease at the Medisch Spectrum Twente in Enschede, the Netherlands. "These exacerbations account for much of the morbidity, mortality and hospital admissions in COPD patients."

The investigators tracked the outcomes of 142 patients divided into two groups. Participants in the first group were instructed in individual drug therapy and other responses to take in the event of an exacerbation. Patients in the second group received no instruction in the self-treatment of exacerbations.

Exacerbations were defined as a clearly negative change in two major symptoms, or one major symptom and one minor symptom. Major symptoms included breathlessness and mucous production and color, while minor symptoms included cough, wheeze, running nose, sore throat and fever.

Patients in both groups were also instructed to maintain journals recording any COPD-related events, as well as medication routines.

In comparing the results of the two groups, researchers noted a significant decrease in doctor's office visits during the study period for the group that received self-treatment training.

"Our results showed that the self-treatment of exacerbations leads to fewer exacerbation days, in combination with an increase in the use of medications," Dr. Effing noted. "Moreover, analyses of the cost-effectiveness of the self-treatment strategy indicated this group experienced cost savings as a result of fewer hospitalizations and healthcare contacts."

Researchers also sought to determine if the self-treatment group would tend to overmedicate when given the option, but Dr. Effing said the study's results indicated that over-medication was not an issue.

"The number of reported courses of medication in the self-treatment group was still lower than the actual number of exacerbations reported in the diaries," Dr. Effing noted. "Given the rise in prevalence of COPD and the costs associated with its treatment, we suggest implementation of programs incorporating careful instruction in self-treatment as part of effective self-management programs in COPD patients with frequent exacerbations."

Source
http://www.scienceda...90517143220.htm

[Dee]

Another interesting, more recent study:

‘Self-Managing’ COPD Might Pose Risks, Study Suggests

May 14, 2012

By Serena Gordon
HealthDay Reporter

MONDAY, May 14 (HealthDay News) — In a finding that seems counterintuitive, a new study revealed that people with chronic obstructive pulmonary disease (COPD) were more likely to die after receiving comprehensive education and self-management tools.

“The comprehensive care management program was associated with unanticipated excess mortality,” wrote study authors Dr. Vincent Fan, of the Veterans Affairs Puget Sound Health Care System in Seattle, and colleagues. They added that this finding differed significantly from previous studies done on self-management in COPD. And, the program used in the study also failed to decrease COPD-related hospitalizations.

You can finish reading this article here:
http://news.health.c...sts/#more-56037

The results are published in the May 15 online issue of the Annals of Internal Medicine