"We should all be concerned about the future because we will have to spend the rest of our lives there." This statement has dire implications for many of us, particularly as we age. According to the U.S. Agency for Healthcare Research and Quality (AHRQ), in 2003 (its latest number for these data) "more than 43% of American adults who suffered from emphysema-the debilitating disease often associated with cigarette smoking-reported that they still smoked in spite of their disease when surveyed by the AHRQ" ("Large percentages of U.S. adults," 2005). When first reviewing these numbers, I thought that I misread the report. But then I remembered what we learned in our professional schools about truly changing behavior-even when the "want to" is there-it is still so very hard. The AHRQ's Medical Expenditure Panel Survey also looked at the percentages of Americans with five other smoking-related diseases who reported that they continued to smoke. Those findings are: asthma, 22.2%; stroke, 21.3%; cardiovascular problems, 19.9%; hypertension, 7.9%; and diabetes, 6% ("Large percentages of U.S. adults"). When you think of the home healthcare patient population with all of these health problems, it is no wonder that it seems many patients continue to smoke-because they do!!
Medicare and Medicaid pay nearly 85% of the national hospital bill for COPD. According to the AHRQ, "COPD, a condition associated with smoking and therefore largely preventable-was the 5th most common cause of hospitalization for Americans over age 65 in 2003. Treating the disease cost Medicare roughly $6.6 billion, or nearly two-thirds of the total national hospital bill ($10.2 billion) for COPD" ("Medicare and Medicaid pay nearly 85 percent," 2005). These numbers may cause their own breathlessness as we think about costs (and taxes) as the population ages.
This April issue of Home Healthcare Nurse addresses varying aspects of respiratory care. Constance Dahlin began her series entitled "It Takes My Breath Away: End-Stage COPD" in the March issue of HHN. This article, accompanied by its continuing education (CE), resumes this month and focuses on the pharmacologic management of end-stage COPD. We know that COPD's etiology can be attributed to all kinds of respiratory conditions. Susan Fay and Mary Curry Narayan offer an overview update and an interesting CE article in "Diagnosis: Tuberculosis." Often, compliance with and management of medications and other components of self-care are key to stabilizing and optimizing COPD and other respiratory problems that can be affected by many factors. One that has engaged or otherwise frustrated home healthcare clinicians is addressed in "Finding the Balance: The Home Care Team Approach to Self-Neglecting Elders" by Ellen Leff and Janel Sonstegard-Gamm. Guidelines for the care of these sometimes challenging clients are provided, as are other helpful implications.
There probably is no population of patients for whom patient education is as important to decreasing incidents of emergent care or exacerbations of symptoms than patients with COPD. In "Breath as a Metaphor for Life," Mary Hindelang seeks to provide the fundamentals that are key to education for these patients and their families. Martha Tice explains the problematic symptom of dyspnea in the Hospice and Palliative Care column "Managing Breathlessness: Providing Comfort at the End of Life," in which a case scenario is woven through the article.
I would like to think that as a group, home healthcare nurses could positively affect smokers, smoking, and its sequelae. To that end, AHRQ's Web site has links to free and easy-to-use, evidence-based materials on smoking cessation. Visit http://www.ahrq.gov/path/tobacco.htm or contact the National Quitline at 1-800-QUIT NOW (1-800-784-8669). The Quitline is through the American Cancer Society and offers resources and counselors for quitting smoking, available in either English or Spanish. And, while we are at it, maybe if we could just get a few good friends to quit, we could all make a difference together and they would not be facing the future with COPD and all that it implies. Together we can make a difference.
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