When I talk to patients with chronic lung disease about their treatment goals, I try to make it clear that we are dealing with chronic disease and that a cure is not, and cannot be, one of the goals of therapy. Treatment goals for patients with COPD are: 1) relieve as many symptoms as possible, 2) preserve lung function and 3) keep the patient out of the hospital. This last goal is important since an exacerbation of COPD, which takes a patient to the hospital, is associated with several dire outcomes.

One thing I mention to patients is that the hospital is where all the disease is. This is not to indict any institution, but is rather a fact of modern life. My particular concern is for my patients that may end up in the intensive care units (ICU). Recent studies have shown that, despite concerted efforts on the part of hospitals, contamination with bacteria, many resistant to our most powerful antibiotics, are living in the ICU.

The most recent studies I have seen found antibiotic resistant bacteria in the sinks and toilet facilities of two ICUs. I want to be clear that the hospitals involved were making serious efforts to eliminate all bacteria, but these contaminants were found even in those sinks used for handwashing. We need more information about the most cost-effective way to handle these issues.

Patients need to seek out-patient attention as soon as possible with an exacerbation to avoid the need for hospitalization.