Saturday, January 26, 2008

The five different types of COPD patients

In RT school we are taught that there are three different types of COPD patients: emphysema, chronic bronchitis and asthma.

In the hospital we tend to leave asthma out of the COPD definition, and the general consensus is that if they smoke it's not asthma.

However, some doctors still diagnose smokers with asthma. I suppose that's their prerogative.

Personally, I am under the belief that if you are an adult with asthma, it is chronic asthma, and falls under the category of COPD.

Emphysema patients are referred to as pink puffers, because they tend to have smaller frames are are not cyanotic. Chronic bronchitis patients are referred to as blue bloaters, because they tend to have larger frames and are often cyanotic.

However you want to define COPD patients that's up to you. Based on my experience working with COPD patients over the years, I have come up with a list of the five different types:

Happy: About 80% of COPDers fit this category. These patients tend to be among the most pleasant of all patients, more so because they are professional patients with a chronic illness and have accepted it. They rarely ask, "Why me?" Happy COPDers generally are of two types: they are either talkative or phlegmatic.

Talkative: About 80% of Happy COPDers are talkative. Some of the best conversations I've ever had with a patient have been with a talkative COPDer. Before their "time is up" they want to share as much of their experiences and knowledge as possible.

When you give a treatment to one of these patients they might not let you leave. They will talk openly about their illness and family life. By the time the patient is discharged you will have a pretty good idea of what kind of a person he was, and what kind of a life he led, prior to getting sick. Usually they are very interesting and intelligent.

If you are talking with a COPD patient, and the patient starts describing an event that occurred in 1945, he is probably a talkative COPDer.

Phlegmatic: About 20% of Happy COPDers are phlegmatic. Whatever you want to do, they don't care. They talk little and have very pleasant and modest dispositions. The majority tend to be men.

If you walk into the room and find the patient has his feet up on the end table while watching TV, you know he is a phlegmatic

If you walk into the room and find the patient is moderately labored and still appears cool and calm, he is most probably a phlegmatic.

Melancholy: About 20% of COPDers fall into this category. They love to be waited on hand and foot. These patients have not accepted that they are sick, and have a tendency to be unpleasant
and very bossy.

When this patient wants a drink, she will say something blunt like, "Drink!" or, "Gimme a drink." Many might pretend they are incapable of lifting the glass so you have to do it for them. If you hear the words like please or thank you, you are probably not dealing with a melancholy COPDer.

Exaggerated: Would you believe it if I told you that a certain percentage of patients actually WANT to be in the hospital. The exact percentage is unknown, but it is estimated to be around 20%, and includes both Happy and Grumpy COPDers.

What happens here is that family members are tired and need a break, so the patient feigns his symptoms to get admitted.

If you need to give a series of Duoneb treatments in ER, but once the patient is on the floor she declines a treatment because she wants to sleep, then you should think exaggeration.

If she is lying in low fowlers and appears to be in no respiratory distress when you walk into the room, but as soon as you grab your stethoscope you hear an audible forced expiratory wheeze, you should think exaggeration.

If she is so bored the day after her admission that she is assisting her elderly room mate walk to the bathroom, then you should think exaggeration.

There are two different types of exaggeration of COPD. When emphysema and chronic bronchitis patients are faking it, the diagnosis is generally exaggeration of COPD. Faking asthma patients are referred to as exaggeration of asthma.

It is important that exaggeration of COPD not be confused with exaggeration of asthma. The differences may not be easily identified once the patient is in the hospital, but must be obtained through questioning, or it may simply be assumed.

Now, I know your science teacher told you not to assume, because when you assume you make an A-S-S out of U and ME. But in this rare instance, it is often necessary in order to make a proper diagnosis of the type of COPDer.

Exaggeration of COPD is when the patient is faking because their family members taking care of them are tired and need a break. So it may be assumed that 100% of exaggeration of COPD patients do not come from nursing homes or assisted living centers.

Exaggeration of Asthma is when the patient is faking because he is stressed and in need of a break from his family. He loves it that when he comes to the hospital he receives special attention and sympathy, and gets waited on hand and foot.

Now, while most of my opinion in establishing this data was obtained at one small town hospital, I believe my sample size and length of study (12 years) was large enough to obtain an accurate stereotype of all COPDers.

However, it must be noted that their is a +/- 6% margin of error on my percentages.

If you disagree with this assessment, or you have an observation of your own, please feel free to let this RT know.

See the 11 types of asthma patients


The Anonymous Therapist said...

This seems to sum it up pretty well. I don't have the 12 years of field experience, just a solid 5, but this seems to reflect reality pretty well. Strong work!

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SouthernRRT said...

This is absolutely true! I actually enjoy visiting with my patients. I tell everyone the nebulizer is just a byproduct. I'm hear for the company. Most of the happy COPD patients are fun to listen to and make my night less boring.

I would add though that there is a percentage of COPD patients that do want to be in the hospital because they are lonely and enjoy the company of the hospital staff. Some are also scared to go back home or to the nursing home. I've even had patients tell me they don't want to go back to the nursing home because the staff is so incompetent, they may end up dead.