Blue Care Network Best Practices
Jackson doctor uses spirometry testing to motivate smokers to quit
For Gary Lynd, D.O., coaching and educating go hand-in-hand with a spirometry test. “I explain to patients that they’re not getting enough air in or out and explain how they can make changes by losing weight, exercising, quitting smoking and using medications appropriately,” he said.
“We programmed our spirometer machines to provide a lung age. If the patient has mild lung disease, he or she may be able to improve lung function. With a smoker who’s about 55 years old, they see the graphs and charts and are still not motivated to stop smoking. But when they see they have a lung age of 80, the light goes on. That is single-handedly the best tool to get people to quit.”
To demonstrate, Dr. Lynd relates the story of a 50-year-old patient who had said he would never quit smoking. The patient is thin and exercises, but he smokes. “The patient said he didn’t have problems breathing, but he met the criteria for testing,” said Dr. Lynd.
“He also said he wasn’t going to quit smoking because he’s been smoking his entire life. I tested him two months ago and, sure enough, his lung age came in at 64. When the patient saw that, the color ran out of his face.” With a combination of nicotine patches and muscle relaxers, the patient has remained smoke-free for a month.
According to the Agency for Healthcare Research and Quality, COPD is the fourth leading cause of death in the United States. And it may be underdiagnosed. Dr. Lynd uses specific criteria to decide who gets spirometry testing in his office. High-risk patients include those who already have COPD, smokers over 50, and patients with a strong family history of COPD or unusual patterns of respiratory disease, such as bronchitis or pneumonia that doesn’t get better quickly, said Dr. Lynd.
He also administers a spirometry test to obese patients who have trouble breathing. “The biggest cause of restrictive lung disease is obesity,” he said. Issues with restrictive breathing can lead to fluid in the lungs as well as scarring of lung tissue, says Dr. Lynd.
He acknowledges that there are challenges with spirometry testing. The equipment is expensive. It needs to be calibrated. The people administering the test need to be trained.
“So we have our nurses do what we call catch-up training to help them administer the test correctly and help patients empty their lungs,” said Dr. Lynd. “There’s a certain amount of patient coaching we do during the test to do it properly.”
The office has also invested in a spirometer that has individual parts that are automatically calibrated. “It’s more expensive because you use a new part each time, but it’s easier to use.”
Helping patients see improvement is one reason to re-administer the test. “A lot of my job is being a coach to my patients,” said Dr. Lynd. “We tell patients if they can catch their lung disease early enough, it’s not always irreversible. We check on how they are doing with efforts to quit smoking and ask about their exercise regimen.”
But the best motivator is feedback, he said. “If I retest a patient after a year of not smoking, losing weight or starting an exercise program, that patient might see slight improvement. But the following year they might see dramatic improvement,” he said.