Innovative program sheds light on benefits of early palliative care

When faced with a long-term illness, patients often retreat or are left feeling hopeless, a response that can negatively impact one's prognosis and impair their quality of life. When coping measures are offered however, the opposite can hold true. Patients can learn to accept their illness, take control of the situation and plan for the future. The Northwestern Asthma-COPD Program is pioneering a new approach to the treatment of patients suffering from Chronic Obstructive Pulmonary Disease (COPD) that combines traditional care and palliative medicine. The forward-thinking approach is part of an emerging trend in medicine to bring palliative care into the equation earlier in order to improve disease management and enhance patient care.

"COPD is a progressive disease that patients grapple with for years," said Ravi Kalhan, MD, pulmonologist at Northwestern Memorial and director of the Northwestern Asthma-COPD Program. "Our program brings together two very different, yet highly important disciplines to provide patients with care that helps them manage their symptoms today, while addressing how the disease may progress so they can keep their eyes open to the future."

The program began incorporating the two disciplines in November and is the first in the nation to formally include a board certified palliative medicine physician in a clinical COPD Program. During regular check-ups, patients who have been identified as having serious illness, see both a pulmonologist and a palliative medicine specialist to address changes in their health, manage symptoms and discuss treatment plans. Pulmonologists focus on treatment for their lung disease, while palliative medicine focuses on the emotional toll of the illness, pain management and long-term planning, including the creation of advanced directives and other documents to help the patient communicate their wishes. Family members are often engaged in the process, helping them cope while also gaining a better understanding of the disease. The approach, known as concurrent care, is gaining traction among physicians who recognize the benefits of early collaboration.

"Palliative medicine can significantly enhance patient care," said Eytan Szmuilowicz, MD, internal medicine and palliative care specialist at Northwestern Memorial. "Patients living with severe disease often have trouble looking ahead to how they wish to handle worsening symptoms. Quality of life preservation and advanced care planning are important topics that should not be ignored – that's where we come in to help."

Szmuilowicz goes on to explain that while historically offered at the end of life, palliative medicine has transitioned into an important part of disease management. "It's about living as well as you can for as long as you can. When patients accept and understand their illness, they are more likely to engage their support system and can make sound decisions about their current and long-term care. Our approach combines symptom management and coping strategies, something that benefits the whole family," adds Szmuilowicz, who is also an assistant professor of medicine at Northwestern University Feinberg School of Medicine.

"This support gives me confidence to live more fully and comfortably," said Don Lartz, a patient receiving care as part of the COPD program. "The doctors made my choices clear to me, which helps me feel more in charge. It's like I have a partner in my care and I always feel better when I leave my appointment."

COPD is now the third leading cause of death in the United States, affecting an estimated 24 million people. Symptoms include breathlessness, wheezing, cough and chest tightness. There is currently no cure for COPD, however specialized care and treatment can prolong life and enhance quality of life.

"COPD may not be curable, but it is manageable. This approach offers patients care that addresses their physical and emotional needs, not just their illness. Through specialized care and support, patients can continue to live full lives," adds Kalhan, who is also an assistant professor of medicine at Northwestern University Feinberg School of Medicine.