Reflecting on My COPD Diagnosis: 8 Years Later

The path to a diagnosis is rarely a straight line. Mine involved various doctors, emergency rooms, and medications that weren’t quite right.

As another birthday approaches, I’ve been thinking about the milestones in my life, from the celebratory to the ones that caused me to pause and reassess the path I found myself on.

I turn now to 8 years ago. I was feeling very ill, with a chronic cough, chills, nausea, and shortness of breath. As I had quit smoking some months prior, a chronic cough was not unusual. But the chest tightness, congestion, and severe of shortness of breath were new to me. Just walking to the bathroom left me severely short of breath.

I went to see my primary care doctor, who referred me for a chest X-ray. His review of the X-ray confirmed the expected pneumonia, but I was surprised when he said, “I’m sorry to tell you, you also have emphysema.”

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A family history and an assortment of medications

Emphysema. My grandmother had emphysema. So did my mom, who received a lung cancer diagnosis shortly after emphysema was found. I was happy to hear that he didn’t see anything that suggested lung cancer, as I expected it to be.

My doctor gave me prescriptions for medications to treat my pneumonia, along with an albuterol inhaler. The medications helped me recover from the pneumonia, but shortness of breath was a symptom that stayed. I was using the albuterol inhaler multiple times a day.

Within 3 months, I had to visit the ER because I could not catch my breath. I was given a breathing treatment via nebulizer at the hospital. When I visited my doctor for a follow-up, I told him how wonderful the breathing treatment was. He prescribed a nebulizer with DuoNeb for me.

All went well with the nebulizer and my albuterol inhaler for another few months, but the severe shortness of breath returned. I returned to the ER. That earned me another prescription, this time for Combivent Respimat.

A few months later, I collapsed on the floor while doing a breathing treatment. My partner called an ambulance, and I was admitted to the hospital for 4 days, three of which I spent using a bi-level positive airway pressure (BiPAP) machine.

Seeing a specialist

The follow-up after this hospital stay earned me a referral to a pulmonologist who conducted a complete pulmonary function test (PFT). Before the PFT was even completed, the pulmonologist handed me a prescription for two inhalers, which I now know to be maintenance inhalers.

My maintenance inhalers have changed a few times over the years, from Incruse Ellipta along with Breo Ellipta, to Incruse Ellipta with AirDuo, to (now) Breztri Aerosphere.

All these inhaler regimens are known as triple therapy, combining a long-acting beta agonist, a long-acting muscarinic agent, and an inhaled corticosteroid. Triple therapy is the recommended maintenance treatment for those with asthma/COPD overlap and those who have had multiple moderate to severe exacerbations.

Lessons learned

It was 15 months from when I visited my primary care doctor with pneumonia and was told I had emphysema to when I had a PFT for proper diagnosis. At that time, I had no idea how COPD was diagnosed.

I know now that a PFT is the gold standard for diagnosis and that a patient with a history of smoking such as mine should have been referred for at least spirometry testing, if not a complete PFT. Had spirometry occurred much earlier, I might have avoided the 4-day hospital stay and the BiPAP.

Over the last 8 years, I have learned so much more about COPD and how I, as a patient, can be proactive in my COPD management and treatment. It has made a world of difference in my quality of life and ability to enjoy activities again.