Should We Take My Father to the ER for Worsening COPD and Lung Cancer?

My father has been getting worse after his recent follow-up visit and hospitalization. Should we go to the emergency room?

My father was diagnosed with COPD five years ago, and his lung function has been declining since then.
Last year, he was also diagnosed with lung adenocarcinoma and underwent chemotherapy.
His last follow-up appointment was around mid-January 2022, where the doctor mentioned that his condition was not good, leading to a two-week hospitalization.
After returning home, his condition worsened.
Recently, he has become completely dependent on an oxygen concentrator to maintain his blood oxygen levels.
Even walking just two or three steps has become impossible for him.

Currently, his condition is most severe in the morning until noon, where his blood oxygen levels are above 95, but he struggles to breathe.
However, after noon, as long as he has continuous oxygen support, he appears to be in a more stable condition.
During his chemotherapy, he could still walk about fifty steps with breaks, but now he is unable to seek medical care on his own (it has only been a little over two months since his last chemotherapy session).
Should we take him to the emergency room immediately?

Cai Huangqi, 40~49 year old female. Ask Date: 2022/02/01

Dr. Zhang Ziyan reply Pulmonology

Hello Mr.
Tsai, regarding your question about whether to go to the emergency room for hospitalization, let me start with the conclusion: it depends on what you expect the emergency hospitalization to accomplish.
During the Lunar New Year period, examinations, medications, and oxygen can be administered, but for other interventional procedures, it may be more prudent to wait until regular business days.
However, if there are acute changes such as altered consciousness, sudden chest tightness turning into shortness of breath, chills, or fever, the emergency room may be of some assistance.

In terms of treatment, the most important aspect for COPD is the use of inhaled bronchodilators.
Are you using them as prescribed? Regarding your lung adenocarcinoma, what stage is it, and what is the genetic profile? Have you discussed prognosis, or is the current approach truly conservative? If it is conservative treatment, what are the treatment goals? I hope this information is helpful.

Sincerely,
Department of Pulmonary Medicine, Changhua Hospital, Ministry of Health and Welfare.

Reply Date: 2022/02/01

More Info

Given your father's worsening condition with COPD and lung cancer, it is crucial to assess whether he should be taken to the emergency room (ER). His reliance on an oxygen machine and the significant decline in his ability to walk indicate that he is experiencing severe respiratory distress. Here are some considerations to help you make an informed decision:
1. Current Symptoms: You mentioned that your father is dependent on the oxygen machine to maintain his blood oxygen levels and that he struggles to walk even short distances. This level of distress is concerning, especially since he was previously able to walk more than fifty steps during his chemotherapy. If he is experiencing shortness of breath, increased respiratory rate (28-30 breaths per minute), or any new symptoms such as chest pain, confusion, or changes in consciousness, it is advisable to seek immediate medical attention.

2. Oxygen Saturation Levels: While you noted that his blood oxygen levels are above 95% with the oxygen machine, the fact that he feels he cannot breathe adequately is a red flag. Oxygen saturation levels can sometimes be misleading if the patient is experiencing significant respiratory distress. If he is unable to maintain adequate oxygenation without the machine or if his condition worsens, it is essential to go to the ER.

3. Potential Complications: Given your father's history of lung cancer and COPD, he is at risk for complications such as pneumonia, pulmonary embolism, or exacerbation of his COPD. These conditions can rapidly worsen and require urgent intervention. If there are any signs of infection (fever, increased sputum production, or changes in sputum color), this would further warrant an ER visit.

4. Medical History and Recent Changes: His recent hospitalization and the fact that his condition has deteriorated since returning home are concerning. It is essential to communicate this history to the ER staff, as it provides context for his current state and may influence the urgency of his treatment.

5. Consulting with Healthcare Providers: If you are unsure about the severity of his condition, consider contacting his healthcare provider for guidance. They may provide specific recommendations based on his medical history and current symptoms.

In summary, given the significant decline in your father's ability to breathe and his reliance on supplemental oxygen, it would be prudent to take him to the ER. The medical team can perform a thorough evaluation, including imaging studies and laboratory tests, to determine the cause of his symptoms and provide appropriate treatment. Early intervention is critical in managing respiratory conditions, especially in patients with complex medical histories like COPD and lung cancer. Your father's health and comfort should be the top priority, and seeking immediate care is a responsible decision in this situation.

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