Posted on March 19, 2021 |
This article was written by Jane M. Martin, BA, CRT
We all know that comprehensive group pulmonary rehabilitation is one of the most effective treatments for COPD with documented improvements in exercise capacity, health-related quality of life, reduced hospitalizations, and possibly improved survival. Thus, it is considered the standard of care for most patients with COPD who have activity limitation.
Despite this, it is estimated that only 2-3% of patients with COPD who are candidates for pulmonary rehabilitation in the United States undertake this treatment program. This is due, in part, to a number of barriers including lack of access, high cost, lack of transportation, poor reimbursement, and physical incapacitation.
While the COVID-19 pandemic has led to many in-person pulmonary rehabilitation programs being temporarily closed, virtual, or remote, methods through telehealth platforms has allowed continued contact with patients and delivery of pulmonary rehab to individuals in their homes.
The outcomes of these programs have been mixed. In general, patients who adhere to a remote program show improved exercise capacity and well-being, but there is a poor record of continued participation in an exercise program. The absence of a sense of community and peer interactions contribute to this poor program adherence and suboptimal outcomes. In addition, many virtual programs have not included the full range of rehab elements.
Posted on February 23, 2021 |
By Michael Stephen, MD
My experience with COVID-19 started on Easter weekend of 2020, when I was pulled from my usual duties to cover overnight shifts in the medical intensive care unit at Thomas Jefferson University in Philadelphia. From the moment I entered the hospital, I felt extraordinary tension and fear; for the first time in many healthcare workers’ lives, we recognized our jobs brought real personal danger.
I remember the first COVID-19 hospital admission I had: a 60-year-old woman who arrived with a smile on her face and a positive attitude – but severe inflammation in her lungs. I’ll never forget her smile, humor, and positivity in light of this devastating infection.
The first two months treating patients with COVID-19 was unlike anything I’ve experienced in medicine. We had no medicines to treat and many patients seemed to decline rapidly with respiratory failure. We also panicked as a medical community, treating with all types of drugs that were unproven.
We abandoned primum non nocere, first do no harm, for primum succerere, rush to help. It was a normal reaction as everybody wanted to do something, but I don’t think it did much good.
Still, despite a feeling of being out control, some patients did well. Their positive attitude certainly helped, and many fought through extreme deconditioning by working hard on nutrition and physical therapy, cornerstones of fighting your way back from any lung disease. The hospital workers showed courage and fortitude, and through it all I never saw a schedule go unfilled or people go absent despite the tremendous personal risk.
Posted on December 08, 2020 |
This article was written by Stephanie Williams, BS, RRT and was reviewed by Byron Thomashow, M.D.
More than 25 years ago, a surgical procedure changed the landscape of emphysema treatments – lung volume reduction surgery (LVRS). The surgical procedure removes emphysematous lung tissue, leaving the healthy tissue able to function better. In carefully selected patients, LVRS reduces dyspnea, increases exercise capacity, and improves quality of life and survival. LVRS was the first therapy since oxygen to show improved survival in advanced chronic obstructive pulmonary disease (COPD). However, LVRS involves a surgical procedure, carries potential risks, and is available in only a limited number of top centers.
Recently, the landscape changed again. There is now a minimally invasive treatment option available for those patients with either heterogeneous or homogenous emphysema – endobronchial valve therapy or, as it is more commonly called, bronchoscopic lung volume reduction (BLVR). This therapy aims to reduce hyperinflation in the lung, improving gas exchange by allowing healthier parts of the lung to expand.1 "Hyperinflation or air trapping in patients who have severe emphysema is a devastating complication that causes increased shortness of breath, decreased exercise tolerance, and worse quality of life,” says Gerard Criner, MD, Chair and Professor, Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University. A typical treatment usually involves placing multiple valves in the airways via bronchoscopy. This reduces patient risk and makes it a therapy possible for more people. The valves are meant to be permanent but are designed to be removed if that becomes necessary at any time.
Posted on July 20, 2020 |
This article was written by Mike Hess, MPH, RRT, RPFT
There’s a lot of talk about how SARS-CoV-2, commonly known as the coronavirus, has changed our world. There are certainly things that are significantly different these days; social distancing stickers dot waiting room floors, “contactless” deliveries have become normalized, there’s a lot more Plexiglass around. We have become much more aware of people around us coughing and sneezing. We’ve started weighing the risks and benefits of participating in activities we once did without a second thought, from going to the movies to seeing friends at a restaurant to getting our hair trimmed. For many of us in health care, the pandemic has, in fact, had a profound influence on our daily routines and rituals.
The same is not necessarily true for our patients, though. Not because they haven’t had to change their day-to-day, but because they were already there.
That point was driven home to me fairly early in the pandemic. For several years now, I have participated in a variety of COPD-centric online and social media groups, from COPD360social to my own group on Facebook, COPD Navigator. I have been fortunate enough to develop connections with people living with COPD, their caregivers, and clinicians across the country. These connections give us the opportunity to see a vast number of different viewpoints and opinions, but the pandemic illustrated something of an anomaly: While many of us were taking to our feeds to talk about how things had changed for us overnight, most of the COPD community was essentially going about their business. They were already distancing. They were already consolidating trips to reduce exposures. They were already washing their hands, and usually already even wearing masks, at least at high-risk contact points. They were already taking all the “new” steps being suggested to protect themselves.
Posted on February 25, 2020 |
Read and comment on our latest PRAXIS case study!
Current Visit: Paul S. is a 60-year-old man with a diagnosis of COPD. He is being seen by his pulmonologist as a sick-visit due to a “cold” he has been unable to recover from for two weeks. Symptoms from this illness have become progressively worse, with increased green sputum production, and increased breathlessness at the time of this visit. Paul has had to take off work for the past three days due to impact of these symptoms and is worried about how much longer it will take him to feel well enough to return to work. This is a big concern for him because he is self-employed as a stone mason and no work means no income.
Posted on December 16, 2019 |
This post was written by Dr. Stephanie LaBedz, pulmonologist and post-doctoral research fellow, and Ellen Stein, senior research specialist. Both authors represented the Breathe Chicago Center at the University of Illinois at Chicago at the November 2019 meeting, “COPD National Action Plan: Tracking Our Progress,” hosted by the National Heart, Lung, and Blood Institute.
Perspectives from Stephanie LaBedz, MD
As a pulmonologist who cares for patients with COPD, I am all too familiar with the many challenges faced by patients with COPD, their caregivers, and the healthcare providers who strive to improve the lives of these patients. In addition, as a post-doctoral research fellow, I understand that despite COPD affecting over 16 million Americans and being the 4th leading cause of death in the United States, research efforts in COPD lag those of other health conditions. The NHBLI’s COPD National Action Plan was an important step in unifying the COPD community toward common goals of increasing COPD awareness and minimizing the burden of disease.
I attended the COPD National Action Plan: Tracking Our Progress meeting in November 2019 with the intent of representing the work of the Breathe Chicago Center and the University of Illinois at Chicago. Although I did have an opportunity to share some of our work, I left the meeting energized by the work others were undertaking as a part of a larger framework to improve the lives of those with COPD. The ideas and activities shared by other participants were innovative and inspiring. I look forward to collaborating in the future with those I met at the meeting to address the ongoing needs of the COPD community.
Posted on July 18, 2019 |
Guest blog by Mike Hess, RRT, RPFT
One of my all-time favorite TV shows is Battlestar Galactica. While I grew up with the campy, cheesy original with Lorne Greene shepherding the “rag-tag fugitive fleet” to a new home among the stars, I actually prefer the more recent 2005 reboot. This version took a much more grounded, realistic approach to storytelling and moral discussion. One of the recurring motifs of the show is the phrase, “This has all happened before, and it will happen again,” and ideas like resurrection, learning from history, and breaking cycles.
Unfortunately, this motif seems to have become all too real for anyone involved in the lung health community. I was recently at a meeting of one of our local Better Breathers groups to discuss the upcoming launch of a new Harmonicas for Health program, and the group facilitator had brought some prints of old cigarette ads. The messages on these ads ranged from the clinical (“20,679 Physicians Say “Luckies are less irritating!”) to the risqué (“Blow in her face, and she’ll follow you anywhere”), but a common theme is that certain cigarettes are awesome. They’re what the cool kids like Lucille Ball and Bob Hope are doing, and some of them can actually even be good for you. After all, if the typical smoker inhales 200 times per day, that’s “200 good reasons you’re better off smoking Philip Morris,” right? They’re proven mild! (**NOTE: Most of these ads are available at https://gizmodo.com/14-absurd-ads-from-before-we-knew-cigarettes-could-kill-1499396560 for citation and/or pictures, Hope/Ball ads are at http://exhibits.library.yale.edu/exhibits/show/sellingsmoke/celebrities**)
We know better these days, of course. We know that no cigarettes are healthy, no cigarettes work to improve asthma, bronchospasm, or anything else, and it wasn’t cigarettes that won World War II. We know that these statements are absurd and ridiculous. But we also know we’re seeing the same kinds of imagery and arguments being used right now to support electronic nicotine delivery systems, or ENDS. These devices, more commonly known as vapes or e-cigarettes, are becoming nearly ubiquitous in modern society, much like smoking once was. And, again as in the case of their combustible ancestors, these devices are being sold as an indispensable accessory for an aspirational lifestyle.
Posted on April 05, 2019 |
Imagine if you will, you’re seeing one of your folks with COPD. Inpatient, outpatient, doesn’t really matter. You’ve seen Mr. or Mrs. X more often than you should have over the past few months. No matter what you do, they keep coming back to your office (or worse, heading to the emergency department) with uncontrollable shortness of breath. You ask them if they’re using their inhaled medications and they tell you, “Yes, of course.” You’ve heard that before, but a quick check of the counter seems in line with at least most of the expected doses. You’ve run through pretty much the whole gamut of meds in the desired class, so now what? There’s nothing left, right? Maybe this is just where they’re going to live from now on.
Or maybe not. Although many people have an idea of inhalers being easy-to-use medication delivery systems because that’s usually what they see on TV, anyone who has ever had to use one (or teach one) knows that’s simply not true. Inhaler technique is a learned skill, no different from driving a car or riding a bicycle (or typing a blog entry). Like many other skills, use of an inhaler is not necessarily mastered quickly or without practice; however, if we truly hope to be effective in helping our patients live their best lives, we must start taking more time to evaluate their technique and guide them toward mastery.
Therein lie a couple of problems. First, we don’t always know what the best technique is. As a respiratory therapist, I’m quite sure I was taught all the steps of proper metered-dose inhaler priming and activation, but I’m also quite sure my polished technique fresh out of RT school eventually got dusty and rusty from disuse. It wasn’t until I started doing outpatient disease management and teaching technique regularly that I discovered I had been teaching the wrong things for who knows how long. I’m not alone, either; a 2014 study of inpatient nurses found that while 71% of those surveyed felt confident in their MDI skill, 79% were observed to have critical errors in their technique.(1) A more recent study published in Respiratory Care even found that fewer than half of pulmonologists surveyed felt confident in their knowledge of inhaler technique.(2) If we can’t teach, how can we expect our patients to learn?
Posted on February 08, 2019 |
Community-acquired pneumonia (CAP), which carries a high morbidity and economic burden worldwide, can be even more physically and economically devastating to individuals with COPD, according to a new study posted online in Chronic Obstructive Pulmonary Diseases: Journal of the COPD Foundation. The study was conducted by the COPD Foundation in collaboration with and funded by Pfizer Inc.
“Patient-Reported Consequences of Community-Acquired Pneumonia in Patients with Chronic Obstructive Pulmonary Disease,” one of the first studies to include only COPD participants and individuals younger than 60, concluded that individuals with COPD suffering from CAP will miss an average of 21 days from work, be impaired from normal activities for more than 30 days and experience weeks of lingering symptoms.
Nearly 500 individuals with COPD who had also recently received a CAP diagnosis completed one survey within 120 days of their initial CAP diagnosis and a second survey 30 days later via the secure online, interactive patient registry—the COPD Patient-Powered Research Network (COPD PPRN). Participants were recruited via multiple routes including posts on the COPD Foundation’s COPD360Social online network, Facebook posts and outreach to existing research participants in the COPD PPRN.
Participants’ CAP diagnoses were self-reported without medical record verification, however 96.5% of participants stated they did have a chest radiograph or computerized tomography to diagnose or confirm their CAP.
Posted on August 15, 2018 |
By Jane Martin, BA, LRT, CRT, Assistant Director of Education at the COPD Foundation
As a healthcare provider for individuals with COPD, you are well aware that many of these individuals have similar experiences related to their disease. The ways patients work with their healthcare providers and what they expect from them can vary greatly. This blog post will touch upon some things that individuals with COPD look for in working with their prescribing healthcare providers, including physicians, physician assistants and nurse practitioners.
A diagnosis of COPD carries with it a unique set of emotions, attitudes and outlooks. Living day-to-day with COPD can cause individuals to feel vulnerable yet sometimes come across as skeptical or even negative. Patients with COPD need healthcare professionals who understand this. In their own words, here are some things to keep in mind:
- It’s important that you really listen to what I’m trying to say.
- Know that I am experiencing loss of physical and social activities – of my former life.
- Know that I may have gone through a long, painful journey of denial to come to this point.
- If my COPD was caused by cigarette smoking, please don’t shame and blame me. At this point, I get it and I need your help.
- I am more than this disease. In spite of COPD, I am still me. I have a life, people I love and who love me, the same as you.
- I have meaningful goals for my life. I may not know where to start in setting goals or if there’s even time left for me to consider them.
- As a person with COPD, I may have to work at having self-confidence and speaking up, especially in interactions with my healthcare providers.
Posted on July 02, 2018 |
This post was authored by Danny Pham, PharmD, BCPS, BCACP, BCGP, Inpatient Care Transitions Pharmacist at Baylor Scott & White Medical Center – Plano. Read more about their successful COPD readmissions reduction efforts in this latest PRAXIS Nexus blog post.
Before we started our COPD program at Baylor Scott & White Medical Center – Plano, our readmission rate was similar to other institutions across the country. We knew there was more we could do to help our patients better understand their condition, be more engaged with controlling their respiratory symptoms, and take a proactive role in slowing the progression of their disease ...
Posted on June 12, 2018 |
For individuals with COPD, there is a lot of medical information to take in. Once they have that information, there is also lots to keep track of – medications, specific nutritional needs, safe exercise methods, level of activity, oxygen use if needed and more. As if this were not overwhelming enough, they must then sort through this information, process it and ask the right questions – vital questions in order to know what they need to manage their COPD and stay well.
You may have heard the old saying “Two heads are better than one.” This really does hold true, especially when it comes to optimizing health. And this is why it can help to have a “health buddy.”
By Bret Denning, JD, COPD Foundation Care Delivery and Communications Program Specialist
In 2018, Pfizer hosted a luncheon briefing, Global Trends in Health Care, with an emphasis on the role patients and patient-led organizations can play in influencing policy.
Moderated by Angela Wasussa, Vice President of Global Policy at Pfizer, the panel featured renowned experts from around the world. The presenters were:
- Durhane Wong-Rieger, President & CEO, Institute for Optimizing Health Outcomes from Canada.
- Eva Maria Ruiz de Castilla, Director for Latin America, Global Alliance for Patient Access (GAFPA) from Peru.
- Regina Kamoga, Executive Director, Community Health and Information Network (CHAIN) from Uganda.
The discussion began with an open question to the speakers, asking, “what is patient-centered healthcare and what are the benefits of such an approach?” All three speakers emphasized the importance of giving patients an active voice in their care and the ability to advocate on their own behalf. On a larger scale, patient-centered healthcare can refer to the active role patients take in advocacy efforts for more research or treatment solutions. Patient voices are a powerful tool to eliminate stigmas associated with any disease.
The presenters also highlighted the need for patient organizations to form coalitions with partners from around the world to strengthen their collective voices and to more effectively set the agenda moving forward. With limited resources, global partnerships can be beneficial and also ensure that underdeveloped nations are not overlooked or ignored. It is also critical that patients and patient groups strengthen their skill sets, not only related to the specific disease they are advocating for, but also on any policy and regulatory matters related to disease management.
Posted on April 19, 2018 |
By Bret Denning, COPD Foundation Care Delivery and Communications Program Specialist
Several COPD Foundation staff members attended a workshop on how the COPD National Action Plan can be used to advocate for better treatment options in rural America. Here is one analysis of the workshop and the common themes that emerged from the day.
I attended a workshop at the National Heart, Blood and Lung Institute (NHLBI), COPD & Rural Health: A Dialogue on the National Action Plan. It was a fascinating conversation on how the different components of the COPD National Action Plan can be transformed from theory into actual practice in rural America.
The workshop began with some sobering facts about COPD in rural America and the unique challenges facing residents of those areas. According to the Centers for Disease Control, COPD rates are significantly higher in rural areas (8.2%) than in urban settings (4.7%). For the most part, residents of rural communities tend to be less educated and more likely to smoke, two traits commonly associated with higher levels of COPD. Access to care is a constant challenge for rural communities and this makes it harder for individuals to be diagnosed with COPD and, perhaps more importantly, to receive the treatment they need to manage their condition.
The program featured a discussion of each component of the COPD National Action Plan with presentation by leading experts in the field. What made this workshop so unique and impactful was the interactive nature of the program. The presentations were meant to facilitate discussion among attendees so they could share experiences and examples of what they are doing in their own communities.
Posted on March 13, 2018 |
Read our next PRAXIS Nexus case study! Today, we will learn more about Meg S., age 62.
Meg S. was referred to pulmonary rehabilitation following a visit with her primary care provider. Here is some of the information shared in the pulmonary rehab intake interview.
Past utilization: Meg has been seen in the ER x 3 over the last three months for extreme shortness of breath, rib pain and intractable cough, feeling as if she’s “choking on my phlegm.” On the second visit, she refused an overnight admission to acute care due to obligations at home. One week later, on her third visit, in addition to nebulizer treatments, low flow O2, and smoking cessation counseling, she was provided with an Acapella device for secretion mobilization.