A woman brushing off her medications and her doctors adivce

COPD Denial

Today I would like to discuss COPD denial. This means you have COPD. It also means you’ve been told you have COPD. Your doctor may even have prescribed medicines to treat it. But, you deny it. You don’t take your medicine. Your diagnosis: COPD Denial.

I have a friend who is scared of COPD

She was diagnosed with COPD. Or, at least that’s what her doctor told her. What she had was senile COPD. This is a type of COPD caused by aging. Or, as she said to me, “My dad smoked a lot in front of me when I was a kid. So, maybe that’s how I got this.”

My friend was never short of breath prior to her diagnosis. She did have allergies. She did have occasional asthma symptoms. But those were always relieved by allergy and asthma rescue inhalers. Since her diagnosis, she was short of breath. She didn’t look short of breath. But, as a lifelong asthmatic, I know you can feel dyspnea and look fine to others. So, I did not brush my friend off.

Instead I took her to the Emergency Room. The doctor gave her a Benadryl. Almost immediately she said she was breathing easy. “The Benadryl made me feel so relaxed, she said.

An x-ray was taken. It did show signs of emphysema.

But, the doctor did what I hoped he would do: not tell my friend about the emphysema. All that would do is stress her out more. And, ever since that day, my friend has been fine. She hasn’t experienced any symptoms. She even gave me the Advair that was prescribed for her. “I don’t need that anymore,’ she said. “It costs too much anyway.”

Did we do the right thing?

Sure, my friend is experiencing no symptoms right now. But, all that probably means is she is in the early stages, or stage 1 or 2. And COPD progression can be slowed. So, I can’t help but think that that doctor and I just delayed the inevitable. That someday her progression will reach stage 3 COPD. And maybe someday stage 4. Someday she will be forced to face it. Someday she will not be allowed to deny.

Best to confront the diagnosis head on

So, what I’m saying here is, I think, it’s best to face your diagnosis. I think it’s important for doctors to be honest with their patients. If you have it, you should know you have it. You should also know what stage you are in. You should know how severe it is.

Why do I say this? Because admitting you have it is the best way to get the best treatment for it. It’s the best way to slow the progression so you can live well and live long for many, many, many more years. That’s why I’m thinking of being honest with my friend. I think I ought to talk her into biting the price of her Advair and just start taking it as prescribed.

This is a dilemma many doctors face

Actually, I see it quite often as a respiratory therapist. You have a patient who is told he has COPD. He was prescribed medicine like Advair to take every day. He says, “I don’t need that. I can breathe just fine.”

So, what do you say to such a person? You know what is best for them. But, you certainly can’t force someone to face their illness and deal with it. It’s easier to just say something like, “Okay, that’s your choice.”

But, sometimes, I think it’s best for doctors to play the role of the bad guy. You don’t want to hear it, but here it is. And your doctor says this despite knowing you may travel in your own way through the “Five Stages of Grief.

It's never easy to break the news of COPD to someone

What to make of this? It’s not ever easy being the doctor who has to tell someone they have a chronic disease called COPD. This is especially true when that person is in the early stages of the disease, a time when symptoms are mild and easy to brush off to aging; a time when no symptoms may be experienced at all. And when you’re told you have it, it’s easy to brush off what the doctor said and go into what I like to refer to as “COPD Denial."

It's one of the hardest parts of my job as a respiratory therapist. To see someone you know has it who doesn't want to admit it. You want to be the bad guy. Sometimes you do bring it up, to no avail. But, occasionally you can convince someone to at least discuss it. And that's a good start.

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