Chronic obstructive pulmonary disease (COPD) continues to be one of the leading causes of disability and death in the United States, yet it remains underdiagnosed and undertreated with treatment historically centered on smoking cessation and a series of inhalers.
At Barnes-Jewish Hospital, WashU Medicine pulmonologists are redefining care for COPD patients through dedicated advanced diagnostics and treatments delivered by nationally recognized physicians who specialize in the disease.
And because patients with COPD often have other comorbidities, such as cancer, cardiovascular disease, or liver disease, Barnes-Jewish and WashU Medicine offer coordinated care across specialties to address a patient’s whole health. Connecting with the right specialists ensures patients receive the right treatments at the right time, helping to prevent complications and hospital stays.
Primary care remains essential in the identification and early management of COPD, and the specialized care offers additional options and advanced treatments, especially for patients with refractory symptoms, frequent exacerbations, or complex comorbidities. For primary care physicians, WashU Medicine COPD care at Barnes-Jewish Hospital can offer clarity in cases where symptoms are out of proportion to pulmonary function test (PFT) findings, where comorbidities complicate management, or where there’s uncertainty around next steps.
Advanced therapies, individualized approach
Effective COPD management starts with the right diagnostics, essential for not only confirming diagnosis, but also assessing disease severity and identifying patients who require advanced therapies.
“Many patients have never had a breathing test,” says Rodrigo Vazquez Guillamet, MD, a WashU Medicine pulmonologist who specializes in COPD at Barnes-Jewish Hospital. “Many haven’t had a CT scan of the chest to look for lung cancer or quantify the amount of emphysema. Many patients with advanced-stage disease have never heard of or don’t think they are candidates for advanced therapies like bronchoscopic lung volume reduction (BLVR), lung volume reduction surgery (LVRS), or lung transplantation.”
For decades, WashU Medicine and Barnes-Jewish Hospital have been leading the way in lung volume reduction surgery, with former WashU Medicine cardiothoracic surgeon Joel Cooper pioneering the surgery in the 1990s.
The goal of treatment is to manage symptoms and prevent acute exacerbations that lead to hospital admissions and mortality. WashU Medicine leverages FDA-approved biologic therapies such as Dupixent® to reduce exacerbations, prevent hospitalizations, and ultimately improve survival. Importantly, the team has the expertise to identify which patients will benefit from these therapies and the experience navigating the prior authorization processes to get them approved.
For those who may not qualify for FDA-approved agents, there’s access to clinical trials led by WashU Medicine physicians evaluating both injectable and nebulized therapies, offering hope to patients who might otherwise exhaust their options.
Pulmonary rehab that meets patients where they are
Once a patient’s symptoms and exacerbations are controlled, they benefit from pulmonary rehabilitation, an often-underused tool in COPD care. WashU Medicine and Barnes-Jewish’s program goes beyond the standard. From high-intensity interval training (HIIT) to one-leg training for people with hypoxemia and adaptive strategies for patients with limited mobility, the program meets patients no matter their ability and helps them regain functional status—and their independence.
“They might be able to go to the supermarket when they haven’t been able to for two or three years,” Dr. Guillamet says. “They’re able to travel or visit children and grandchildren.”
Surgical and interventional options in one place
For patients with severe hyperinflation, WashU Medicine physicians can evaluate them for bronchoscopic lung volume reduction (BLVR) or lung volume reduction surgery (LVRS), which can be an alternative to lung transplant. Since pioneering the development of LVRS in 1993, WashU Medicine surgeons have performed more than 200 surgeries, making the program one of the most active in the country. The goal of surgery is to remove nonfunctioning portions of the lung that compress healthy tissue and limit respiratory mechanics. The result can be dramatic: improved oxygenation, better exercise tolerance, and, in some cases, longer survival.
Many of these patients may also be transplant candidates down the line. “These therapies can be staggered,” Dr. Guillamet says. “In patients with advanced-stage COPD that is heterogenous in distribution, who are good candidates for LVRS or BLVR procedures, they benefit for a few years, and then the benefit wears off. Those patients could still be candidates for lung transplantation. However, they need access to experts who offer it.”
The WashU Medicine and Barnes-Jewish Transplant Center is one of the top transplant centers in the country. Since 1963, WashU Medicine surgeons have performed more than 2,100 lung transplants. This deep experience, coupled with a commitment to advancing research on managing acute and chronic rejection, the role of respiratory infections in the development of chronic rejection, and the impact of humoral immunity on long-term outcomes, has led to consistently strong survival rates, both short- and long-term. Patients typically are on a waiting list for about three months before receiving a lung transplant.
Comprehensive evaluation and treatment for comorbidities
For some, COPD doesn’t exist in isolation. Patients with COPD also frequently have cardiovascular disease, liver disease, cancer, aneurysms, or other conditions that complicate their management. WashU Medicine physicians at Barnes-Jewish Hospital have integrated pathways to hepatology, cardiology, and oncology—ensuring rapid access to the right subspecialists when issues arise. Patients with cancer can be referred to Siteman Cancer Center, national leaders in cancer care based at Barnes-Jewish Hospital with WashU Medicine.
“Those patients benefit from being at a center like ours, where we can not only detect other conditions, but we can also manage them with experienced specialists in those areas,” Dr. Guillamet says.
This is especially critical in patients with Alpha-1 antitrypsin deficiency. “They develop COPD much faster than other groups of people. We have extensive experience in identifying those patients who need replacement therapy,” Dr. Guillamet says. “Commonly, there are problems with the liver—they develop cirrhosis and liver cancer more frequently. We work with the hepatology team to make sure these patients get the appropriate therapies.”
Referring for COPD care: When and why?
There’s no wrong time to refer. WashU Medicine physicians see patients at any stage of the disease, whether they’re newly diagnosed, struggling with refractory symptoms, or recovering from hospitalization. Many patients are seen for a one-time consultation and transition their care back to their primary provider with a tailored plan; WashU Medicine physicians follow others longitudinally.
Recent examples of patient successes include patients who were frequently hospitalized before referral not being readmitted since being seen and starting the right therapies. Another patient was afraid to visit family in high-altitude Denver. Thanks to a referral, testing that assessed the disease stage, and pre-arranged oxygen support, they were finally able to travel, see where their family lived, and visit grandchildren.
“These are life-changing interventions,” Dr. Guillamet says. “Not just in terms of lung function or hospitalization rates, but in restoring people’s ability to live meaningful lives.”
COPD is complex, often progressive, and rarely straightforward. But with the right tools and a collaborative care model, patients can experience meaningful improvement. At Barnes-Jewish Hospital, WashU Medicine COPD care stands at the forefront—changing how we think about, diagnose, and treat this disease.
To learn more or refer a patient for evaluation, call 314-454-8917.
