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Questions Not Focused on Smoking History Can Help Identify COPD

feb2016_004According to a study presented at the European Respiratory Society’s International Congress this past September suggested that there may be a way to identify if an individual is suffering from chronic obstructive pulmonary disease (COPD) without hounding them with questions about their smoking habits. This tool may even have a way to “speed up the diagnosis time and reveal COPD before serious exacerbations and further loss of function occurs.”

The research team noted that they felt “COPD is under diagnosed, partly due to subpar screening tools that rely on smoking history and patient reported cough and sputum.” They sought to find a screening tool that would help more individuals get diagnosed faster, leading to quicker treatment.

The results of this were a set of five “yes or no” questions that had the ability to identify “whether a person had moderate or severe COPD, or if people were at risk for COPD exacerbations. The questions asked about breathing, how easily a person got tired, and acute respiratory illness.” It was found that the questions were able to not only identify people before they have serious complications of COPD, but also included an assessment of exacerbation risk, as noted by the researchers.

The team also noted that in the future, they hope the questionnaire can “improve how physicians find COPD”, and also pinpoint patients with “more severe disease and those at risk for exacerbations, so they can be treated.” 

Click here to Access the Full Story from HCP Live

How Stem Cell Therapy May Help Treat COPD

feb2016_001Most of us have heard of stem cells, but not as many know how helpful they can be for chronic conditions such as chronic obstructive pulmonary disease (COPD). Between the story below and the results of recent treatments using stem cell therapy, you can determine for yourself if this type of treatment is right for you or someone you know.

Our story begins with a woman namedMarilyn Calick. Marilyn had suffered from asthma for her entire life, but over the past decade she had also developed COPD, forcing her to use steroids and a rescue inhaler daily. This type of condition and treatment is all too familiar for many Americans.

While the medications helped manage her symptoms, they weren’t anything close to a permanent solution. If she were to stop taking the medication, her symptoms would come back, sometimes worse than before. Marilyn felt like she was running out of options. That’s when she reached out to Dr. David Borenstein, an integrative medicine physician in New York City.

Dr. Borenstein is just one of many physicians in the US using stem cells to treat certain diseases, including COPD. The stem cells, “which can self-renew and replace damaged areas of the body”, are drawn from the “patient’s buttocks or midsection during liposuction, and then separates the stem cells in a centrifuge. Next, stem cells are mixed in a solution, which is administered through an IV and put into a nebulizer, from which the patient inhales them.”

Dr. Borenstein says that about “two-thirds of his patients see COPD relief within several weeks to about five months, and that those results last for about a year.” These results sound much more promising than daily medication and a decreased quality of life. The procedure costs about $8,000, which is usually less than the more invasive lung reduction surgery that is more common.

After having the procedure even Marilyn can attest to an improved quality of life, saying she can now “go out with different friends, stand for long periods of time and walk places”.

Click Here to Access the Full Story from Fox News Health

New Infographic Report Helps COPD Patients Pick Appropriate Health Plan

Jan2016_2We all know how difficult it can be to select a health plan from the multitude of options available, especially if you are dealing with a chronic disorder such as emphysema or chronic obstructive pulmonary disease (COPD). To help make the process easier, the American Lung Association has developed an “infographic to guide patients through the process of picking a health plan through Healthcare.gov or a state exchange”.

This helpful and easy-to-understand guide helps Americans who are not yet eligible for Medicare “determine the best health plan available to them.” Because COPD is a high-cost health need, it is important to consider all factors associated with the condition and what those will mean for your out-of-pocket costs (i.e. premium, deductible, co-pay, etc.). The infographic also advises individuals to account for a plan’s coverage for doctors and specialists, as well as hospitals and medications.

American Lung Association President and CEO, Harold P. Wimmer, addressed concerns associated with plan selection stating: “understanding the true total cost associated with each of the available plans is so important. Having access to care doesn't help patients with COPD unless they can afford to utilize it”.

While COPD is not able to be cured, it is treatable. With the proper access to treatment options and medical care, COPD patients can improve their quality of life.

Click Here to Access Infographic from American Lung Association

COPD Predicted By Expiratory Snoring in Sleep Disordered Breathing

Jan2016_1If you haven’t heard of sleep disordered breathing (SDB), you may want to see some new study findings. According to a recent study, SDB, which is described as expiratory snoring, can help predict obstructive airway disorders such as emphysema, asthma and chronic obstructive pulmonary disease (COPD).

Published in the December edition of Annals of the American Thoracic Society, lead study author Abdulrazak Alchakaki, MD, from the John D. Dingell VA Medical Center and colleagues“examined whether the presence of airflow obstruction could be predicted by the presence of expiratory upper airway narrowing during sleep among 93 males with SDB”. Study participants underwent in-lab polysomnography, a sleep study associated with oxygen intake, and complete pulmonary function tests in order to test for airway obstruction.

Researchers found that those participants with expiratory snoring, associated with SDB, “had increased odds of having evidence of lower airway obstruction – with smokers also having increased odds”. Additionally, researchers noted that patients showing these symptoms should be more “carefully assessed for pulmonary disorders such asthma and COPD”. This information will be beneficial for doctors and potential patients moving toward diagnoses and treatment of airway obstruction.

Click Here to Access the Full Article from Neurology Advisor

Adding 'Flowsheet' to EHRs Can Help With COPD Management

The outcome of a new study published in Respiratory Medicine indicated that “integrating electronic health records into the outpatient process for individuals with chronic obstructive pulmonary disease (COPD) can help disease management for such patients.”

How so? Let’s explore:

Study researchers knew that COPD required lifetime management, citing patients whose disease went unmanaged often end up hospitalized or at the emergency department, how to best and most-easily manage the disease, however, was unclear. It was decided that study researchers would “develop a standardized COPD "flowsheet" based on clinical guidelines.” The flowsheet was then “embedded in patients' EHRs and appeared on the providers' screen during COPD outpatient visits.”

The researchers then viewed study participants’ (some used flowchart and others did not) medical records and “compared their status before and after the addition of the flowsheet.” Based on their observations, the researchers hypothesized that a “structured approach that used information in the EHR system would boost compliance with clinical practice guidelines for management and evaluation of patients with stable COPD.”

Based on findings, the researchers concluded that those patients using the recommended flowchart experience an “improved advanced assessment of COPD and other quality-of-life measures”. Of these, researchers distinctly saw improvements in the areas of “influenza vaccinations, inhaler technique education, referrals to rehabilitation programs, use of long-acting lung medications, use of short-acting rescue inhalers and use of tools to for measuring a patient's COPD.”

Due to these positive findings, researchers noted that the “implementation of a standardized COPD flowsheet developed from clinical practice guidelines [is key to] improving advanced assessment of patients with COPD.”

Click Here to Access the Full Study in Respiratory Medicine

Does COPD Begin in Childhood?

dec2015 2To mark World COPD Day,an annual event organized by the Global Initiative for Chronic Obstructive Lung Disease (GOLD) to improve awareness and care of chronic obstructive pulmonary disease (COPD), Lystra Hayden, Instructor in Pediatrics at Harvard Medical School, set on a task to discover the relationship between childhood pneumonia and COPD development in smokers.

A recent publication in Respiratory Research, examined the risk for COPD in adult smokers who had pneumonia in childhood. With 10,000 participants ages 45-80, the study concluded that “adult smokers, having had childhood pneumonia was associated with a higher risk of COPD, decreased lung function, and increased disease of the airways on chest CT scans.” Additionally, Hayden noted that “the greatest association with COPD was seen in subjects who had both pneumonia and asthma during childhood.”

It is the researchers hope that these findings will help medical providers to “decrease the risk of future COPD by trying to prevent childhood pneumonias, especially among asthmatics.” Based on the findings, Hayden also suggested that medical providers offer counsel to patients who had pneumonia in childhood of the increased risk for COPD if they start smoking.

In the future Hayden hopes to use these outcomes to identify genetic associations that could define subtypes of COPD.  Hayden is hopeful that through genetic testing, understanding a patient’s genetic risk will help physicians better understand who will develop lung diseases such as asthma and COPD, while discovering the “best ways to both prevent disease and treat each individual patient.”

Click Here to Access the Full Story in BioMed Central

Current Diagnostic Criteria for COPD Inadequate, Experts Say

Current Diagnostic Criteria for COPD Inadequate, Experts SayA recent analysis published in the BMJ details findings that indicate chronic obstructive pulmonary disease (COPD) management programs and guidelines consistently over-diagnose elderly patients and underdiagnose young ones. The analysis calls for the adoption of “lower limits of normal (LLN) criteria for airflow obstruction that are specific for different populations.”

Martin R. Miller, MD, from the University of Birmingham in the United Kingdom, and Mark L. Levy, MBChB, from the Harrow Clinical Commissioning Group in London, United Kingdom, created the Global Initiative for Obstructive Lung Disease (GOLD) strategy with the intention to create “a new and simple threshold for airway obstruction.” Unfortunately, upon diligent new research, Miller and Levy both concluded that the GOLD standard – created in 2001- did not effectively diagnose COPD.

Miller and Levy also calculated that “as many as 13 percent of patients diagnosed with COPD under the GOLD criteria may be misdiagnosed (under-diagnosis as well as over-diagnosis). This misdiagnosis could lead to poor outcomes that result from inappropriate treatment.” Misdiagnosis may also result in patients missing out on necessary treatment.

The goal of Miller and Levy’s ongoing research is to help physicians move beyond spirometry and the GOLD standards, which can create “the myth of a health smoker”, and allow them to more accurately “diagnose patients who have symptoms of COPD. This is necessary because COPD is currently under-diagnosed during the early stages of disease, when preventive strategies might be most useful.”

Subsequently, the National Institutes of Health has also funded a study to “facilitate diagnosis of COPD in smokers and other patients. The goal is to create a five-question questionnaire that is able to diagnose clinically significant COPD.” Until the new guidelines are releases, Miller encourages physicians to incorporate “clinical perspective” into their tests for diagnoses.

 

Click Here to Access the Full Story on Medscape

 

Study Shows COPD Re-admissions Can Be Reduced

A new sleep center study shows re-hospitalization of patients with chronic obstructive pulmonary disease (COPD) can be significantly reduced using a multi-faceted approach.

Published in Journal of Clinical Sleep Medicine, Steven Coughlin, PhD, Director of Strategy, Health Economics and Reimbursement at Philips Respironics, and colleagues used a retrospective approach to look at a quality improvement (QI) program and its effect on patients with COPD.

The program focused on COPD patients who had been hospitalized “twice in a single year as a result of acute COPD exacerbation.” Those patients were then treated according to a multi-faceted intervention plan that included:


●       nocturnal administration of advanced positive airway pressure (PAP), or noninvasive positive pressure ventilation (NIPPV)
●       medication reconciliation by a pharmacist
●       adequate provision of oxygen
●       patient education
●       ongoing respiratory therapist-led care
 
The proportion of patients who were readmitted the following year decreased by almost 80%, from 397 to 9 out of the 397 patients that met all of the eligibility criteria. “A total of 70 patients died during within one year of the initiation of the intervention.”
 
In a recent development, the Centers for Medicare and Medicaid Services (CMS) has begun tracking COPD-related re-hospitalizations. Additionally, the Agency of Healthcare Research and Quality (AHRQ) “classifies COPD as a condition for which good outpatient care can potentially reduce hospitalization, prevent complications, and reduce disease severity.” While this study focused on “only one quality improvement program and one sleep center, the authors say it provides enough information to warrant further research.”

Click Here to Access the Full Story on HCP Live

Living an Active Life with COPD

Living with COPDFor those living with chronic obstructive pulmonary disease (COPD), exercise can be a daunting thought. Some people may even fear the idea, as it is oftentimes a very difficult challenge. COPD makes even simple physical activities like “a short walk or climbing the stairs exhausting, but research shows that exercise can “improve COPD patients’ physical and emotional well-being, while inactivity can worsen their condition.”

“As a person’s symptoms become more severe, they’ll avoid any kind of activity that will cause breathing distress,” Randolph Lipchik, MD, a pulmonologist at Froedtert Hospital and the Medical College of Wisconsin in Milwaukee. “This leads to a spiral of slowly becoming more and more deconditioned, and unable to do even basic physical activity.” Additionally, the American College of Sports Medicine warns that if COPD patients choose to remain inactive, their heart function and muscle mass can decline.

When people suffer from the shortness of breath and lack of energy associated with COPD, they tend to give up activities they used to enjoy as well as social interaction, leading to an estimated 40 percent of patients suffering from depression. Researchers recommend checking with a doctor before beginning any kind of exercise program as they may want to “monitor oxygen levels and heart rate, and suggest working with a therapist to identify the right exercises for you.”

“Sometimes [patients] need reassurance that they’re okay to do something that’s not a marathon,” says Ashley Henderson, MD, director of the pulmonary diseases and critical care medicine fellowship program at University of North Carolina School of Medicine.

Recommended exercises include low-impact aerobic movements such as “walking, riding a stationary bike, and swimming use large muscle groups and can help improve breathing. Lipchik adds that “mild strength training, such as lifting light weights, can prevent muscles from weakening. But don’t overdo it”, he says.

Click Here to Access the Full Story on Everyday Health

Order Sets Help Decrease COPD Hospitalization

Order Sets Help Decrease COPD HospitalizationAccording to a recent study published in the Canadian Respiratory Journal, the use of order sets by physicians for the management of chronic obstructive pulmonary disease (COPD) is able to reduce hospitalization time and medication use outcomes. Hospitalization time and frequency continues to be a problem for patients of chronic diseases, specifically those with COPD, whose symptoms can flare from any number of activities.

Not familiar with order sets?

Order sets are a series of checklist recommendations designed to assist physicians in the decision making process about the most appropriate course of care in COPD patients. With COPD acting as the leading cause of hospitalization COPD in Canada, Samir Gupta, lead investigator of the study and a respirologist at St. Michael’s Hospital, was prompted to seek out just how helpful order sets are to lessening hospital admissions for those with worsening COPD.

Gupta believed that “by providing doctors with the best, evidence-based information at the point in time when they are deciding on medications and tests for their patients, doctors’ adherence to best practices [will improve].”

Study researchers “encouraged both physicians and other members of the hospital staff to use the order set, which provided comprehensive admission instructions. The checklist was created by a team from the respirology and internal medicine wards at St. Michael’s, particularly focusing on patients who were admitted to the hospital due to worsening COPD”.

Results indicated that the “length of patients’ average hospital stay decreased approximately two-and-a-half days in cases where physicians used the order sets”. “This is a dramatic drop, and points to one of the key, positive findings in our research,” noted Gupta. “The faster we can get patients home and breathing easier, the better for our patients and for our health-care system.”

Other findings indicated that that more patients were treated with proper antibiotics, leading to “fewer cases of over-treatment and antibiotic resistance, according to the order sets”.

Click Here to Access the Full Study on Canadian Respiratory Journal

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