If You Have COPD, Do You Set Goals?

Study Shows That Patients with COPD Struggle to Identify and Set Goals

Background: Health care professionals generally treat those with various chronic diseases according to guidelines that are developed for the specific condition. For example, the 2017 Global Initiative for Obstructive Lung Disease (called GOLD) Strategy emphasizes two goals of treatment for COPD: 1. Improve symptoms, which is mainly shortness of breath; and 2. Reduce the risk of a flare-up (called an exacerbation).

However, individuals who have COPD may have other interests related to their breathing. Hopefully, your health care professional will ask, “What are your goals for improvement?”

Dr. Boeckxstaens authored an article of how patients with COPD can set goals

Dr. Pauline Boeckxstaens of Ghent University in Belgium

Study: Dr. Boeckxstaens and colleagues at Ghent University in Belgium interviewed 19 patients diagnosed with COPD who had other medical conditions (called comorbidities) like diabetes, high blood pressure, or heart disease. The interviewers asked patients about their goals and how to identify  them. The study results were published in the November 2016 issue of the Journal of Comorbidity (volume 6: pages 120-126).

Results: In general, the investigators found that patients do not naturally state or express their personal goals even when different interviewing techniques are used. The authors suggested that there were four main reasons for this: 1. Patients may find it difficult with the concept of goal setting; 2. Patients may accept their situation or limitations rather than set goals; 3. Various stresses (like family issues or fear to having a breathing attack) may be of greater concern than setting goals. 4. Some patients may consider their own goals as being selfish.

Conclusions: The authors suggest that health care professionals help patients identify their personal goals rather simply accept what guidelines recommend.

My Comments: At your first visit or interview for starting pulmonary rehabilitation, the nurse or therapist will ask, “What are you goals for improving? What do you want to do that is difficult now?” The response may be as simple as being able to play with grandchildren or to go to lunch/shopping with friends. This process in intended to help the person“set goals” in order to improve.

list to help set goals

Goal Setting

I encourage anyone with a health problem, such as COPD, to consider and to ask yourself, “What are my goals?”  Then, set a plan with your health care professional because

“A goal without a plan is just a wish” by Antoine de Saint-Exupéry.

New Alpha-1 Guidelines for Testing and Treatment

Alpha-1 Guidelines Updated from 2003

The new Alpha-1 guidelines for testing and managing Alpha-1 Antitrypsin Deficiency are published in the July issue of the Chronic Obstructive Lung Diseases: Journal of the COPD Foundation. The guidelines are intended to update and simplify a 2003 document from the American Thoracic Society (ATS) and the European Respiratory Society on the diagnosis and management of Alpha-1.

Alpha-1 is an abbreviation for a genetic, or hereditary, form of emphysema. It is called Alpha-1 Antitrypsin Deficiency. The Alpha-1 protein is made in the liver, released into the blood, and travels to the lung. It protects the lung from damage due to cigarette smoking. If there is a low level in the lung and a someone smokes cigarettes, emphysema can develop at an early age or may develop at a later age in someone who has not smoked that much.

author of new Alpha-1 Guidelines

Robert Sandhaus, M.D., Ph.D.

“We believe the Summary of Recommendations of these guidelines is the most efficient tool that busy physicians have ever had to follow best practices in detection, diagnosis and treatment of Alpha-1 in adults,” said Robert Sandhaus, MD, PhD, who co-chaired the Guidelines committee. “The Alpha-1 community has long needed more accessible guidelines based on the latest scientific literature.”


Major Recommendation for Testing

“All individuals with COPD regardless of age or ethnicity should be tested for Alpha-1 deficiency.”

Augmentation Therapy 

Augmentation therapy builds up the Alpha-1 protein in the lung for better protection to prevent any additional damage. The Alpha-1 protein is obtained from healthy adults, concentrated, and then given through a plastic tube placed in an arm vein once a week to prevent emphysema from worsening.

My Comment: If you have COPD, make sure that you are tested for Alpha-1 deficiency.  Your health care provider can order a simple blood test to find out about this diagnosis.