Faculty Group Practice Newsletter

Each November, COPD Awareness Month spotlights chronic obstructive pulmonary disease, a condition affecting millions of people and requiring specialized, ongoing care.

COPD is a progressive lung disease often linked to smoking, though it may also be tied to genetics or environmental exposure to smoke or other pollutants. Shawn Nishi, MD, Division Chief ad interim for Pulmonary Critical Care and Sleep Medicine at UTMB, says many patients experience symptoms long before seeking medical attention.

“Shortness of breath is one. A productive cough over a long time can be another sign,” Dr. Nishi says. “It might be very subtle, and people usually say, ‘Well, I'm just getting older and that's why I can't walk as far, or why I get more short of breath than someone else.’ But those subtle things catch up with you after a while, and people realize that's really not normal.”

Though many individuals try to self-diagnose COPD based on symptoms, Dr. Nishi emphasizes the importance of spirometry in confirming COPD.  This simple test measures lung function, helping confirm whether symptoms truly indicate COPD or another condition, an essential step given the high rates of misdiagnosis.

“Just like you cannot diagnose hypertension without a blood pressure check, you also cannot diagnose COPD without spirometry,” she says.

Medications delivered via inhaler play a vital role in COPD management. Because some patients may struggle to breathe deeply enough for the medication to adequately reach their lungs, it is important to understand each patient’s inspiratory capacity so the correct inhaler type can be prescribed.

COPD management also extends beyond medication. UTMB offers pulmonary rehabilitation as an outpatient program to help patients manage their disease, return to daily activities, and increase quality of life.  Pulmonary rehab program is a comprehensive, multidisciplinary approach that includes exercise, education on medication usage, breathing techniques, and lifestyle adjustments.

“We have respiratory therapists that do testing, assessments, and surveys on these patients to figure out what their quality of life is like and what can we do in pulmonary rehab to improve that,” Dr. Nishi says.

This can include adjustments to diet and exercise, or having occupational therapy assess the placement of household items to minimize reaching overhead too high or bending too far. Pulmonary rehab also empowers patients with breathing exercises that teach them to manage their symptoms effectively. Patients with COPD may enter pulmonary rehab with a physician referral. There are four locations within the UTMB Health System.

UTMB’s comprehensive approach to COPD care is led to its recognition as a Joint Commission Center of Excellence for COPD, helmed by Alex Duarte, MD. Developed in conjunction with the American Lung Association, this advanced certification provides standards for outpatient and ambulatory care settings including staff education requirements, use of spirometry, smoking cessation, risk factor reduction, coordination of care, and patient education on self-management of COPD.

The effect of UTMB’s COPD Center of Excellence on patient care has resulted in reduced ED visits and hospitalizations for patients managed at accredited COPD clinics compared to usual care over a four-year period (2014-2018). These findings were published in 2023 as a peer review manuscript titled “Structured evaluation and management of patients with COPD in an accredited program.” UTMB first earned the designation in April 2015.

The accreditation is a strong reflection on the team of physicians, Advanced Practice Providers, respiratory therapists, and nursing and administrative staff who ensure the best care of our COPD patients - both inpatient and ambulatory. 

It is also a testament to UTMB’s capacity for primary care to effectively diagnose and manage COPD for many patients. These providers typically have a good understanding of risk factors and symptoms, Dr. Nishi says, and they can help their patients manage their COPD without referring to a pulmonologist.

More complex cases are referred to specialists like Dr. Nishi, who can offer advanced treatment options, including biologic therapies (recently approved for COPD) and innovative procedures such as endobronchial lung volume reduction. This minimally invasive procedure involves placing a one-way valve in the lung to relieve hyperinflation, alleviating severe breathlessness in suitable candidates.

Preventing exacerbations is crucial in COPD management, since lung function deteriorates with each episode. Vaccinations, good hand hygiene, and avoiding sick contacts can all help reduce exacerbations.

For COPD Awareness Month, Dr. Nishi encourages primary care providers and patients alike to recognize the early signs of COPD, understand the importance of diagnostic testing, stay proactive in prevention, and explore comprehensive care options.

Shawn Nishi, MD, sees patients at the UTMB Health Pulmonary and Sleep Medicine Clinics in Galveston and Clear Lake. Learn more about Pulmonary Care at UTMB Health.