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COPD Research: The Present & Future

COPD Research: The Present & Future

While research has made large strides in the assessment and treatment of patients with COPD in recent years, a number of important questions remain to be answered. The American Thoracic Society and European Respiratory Society have teamed up to publish a joint statement that describes current evidence on the diagnosis, assessment, and management of COPD; identifies gaps in knowledge; and makes recommendations for future research. Current Needs Perhaps the biggest need that spans all areas of COPD research is to determine which outcomes matter most to patients and then to ensure that research studies measure these outcomes. “Understanding what patients care about is the basis of patient-centered care,” says Kevin C. Wilson, MD, co-author of the statement, which was published in the American Journal of Respiratory and Critical Care Medicine. Physiological and/or anatomical outcomes are used frequently in studies because they tend to be easier to measure. Such surrogate outcomes, however, should strongly correlate with patient-centered outcomes if they are used in clinical research. Examples of patient-centered outcomes include quality of life, dyspnea, and frequency and severity of exacerbations. Determining the optimal method for diagnosing COPD based on spirometry is another important research need according to Dr. Wilson. It is undetermined whether the diagnosis of COPD should be based upon a fixed threshold or the lower limit of normal for the FEV1/FVC ratio. A post-bronchodilator FEV1/FVC ratio of less than 0.7 has traditionally been the criterion for airflow limitation. However, this threshold may result in more frequent identification of airflow limitation among the elderly and less frequent diagnoses among patients younger than 45 when compared with a threshold based...
CME: The Increasing Costs of COPD

CME: The Increasing Costs of COPD

Chronic lower respiratory disease—the large majority of which is COPD—currently ranks as the third leading cause of mortality in the United States. Recent estimates of the costs associated with chronic lower respiratory disease have presented asthma and COPD together, which does not allow for a true understanding of the costs of COPD to the national healthcare system. Fur-ther complicating available data is the fact that patients with COPD often have a multitude of comorbidities. “Most COPD is attributable to smoking, which can also cause heart disease, cancer, and many other conditions,” explains Earl S. Ford, MD, MPH. “This makes it difficult to understand what costs are directly attributable to COPD and what costs are actually attributable to conditions that co-exist with COPD. Some of the previous studies looking at the costs of COPD have likely included ‘double counting’ from not factoring in costs that are actually attributable to these comorbidities.” A Thorough Analysis For a study published in Chest, Dr. Ford and colleagues estimated national and state-specific COPD-attributable annual medical costs by payer and absenteeism in 2010 and projected medical costs through 2020. The team used the 2006 to 2010 Medical Expenditure Panel Survey, 2004 National Nursing Home Survey, and 2010 CMS data to generate cost estimates and 2010 census data to project medical costs through 2020. “We felt that the most presentable costs were those that were estimated after accounting for 11 comorbidities, including heart disease, pneumonia, diabetes, asthma, and depression,” adds Dr. Ford. After accounting for these other comorbidities, the researchers estimated that the 2010 costs attributable to COPD and its sequelae were $32.1 billion (Figure). By...
The Increasing Costs of COPD

The Increasing Costs of COPD

Chronic lower respiratory disease—the large majority of which is COPD—currently ranks as the third leading cause of mortality in the United States. Recent estimates of the costs associated with chronic lower respiratory disease have presented asthma and COPD together, which does not allow for a true understanding of the costs of COPD to the national healthcare system. Fur-ther complicating available data is the fact that patients with COPD often have a multitude of comorbidities. “Most COPD is attributable to smoking, which can also cause heart disease, cancer, and many other conditions,” explains Earl S. Ford, MD, MPH. “This makes it difficult to understand what costs are directly attributable to COPD and what costs are actually attributable to conditions that co-exist with COPD. Some of the previous studies looking at the costs of COPD have likely included ‘double counting’ from not factoring in costs that are actually attributable to these comorbidities.” A Thorough Analysis For a study published in Chest, Dr. Ford and colleagues estimated national and state-specific COPD-attributable annual medical costs by payer and absenteeism in 2010 and projected medical costs through 2020. The team used the 2006 to 2010 Medical Expenditure Panel Survey, 2004 National Nursing Home Survey, and 2010 CMS data to generate cost estimates and 2010 census data to project medical costs through 2020. “We felt that the most presentable costs were those that were estimated after accounting for 11 comorbidities, including heart disease, pneumonia, diabetes, asthma, and depression,” adds Dr. Ford. After accounting for these other comorbidities, the researchers estimated that the 2010 costs attributable to COPD and its sequelae were $32.1 billion (Figure). By...
Predicting COPD-Related Mortality in the Elderly

Predicting COPD-Related Mortality in the Elderly

About 10 years ago, researchers validated the BODE index—which stands for BMI, airflow obstruction, dyspnea, and exercise capacity—as a prognostic mortality risk tool for patients with COPD (Table 1). “The development and validation of the BODE index was an effort to more fully characterize disease severity in patients with COPD,” explains Melissa H. Roberts, MS, PhD. “It captures not only the clinical measurements of COPD through a lung function test, but also some of the systemic effects of the disease that can appear in patients with COPD.” Since 2004, many studies have demonstrated that the BODE index is a more accurate predictor of mortality among patients with COPD than lung function alone. Additional analyses have shown that the index can also serve as a good predictor of severe COPD exacerbations resulting in hospitalization. Over this same stretch of time, other studies have assessed modified versions of the BODE index to determine if other measurements may offer additional value, but these analyses have had mixed results. A Simpler Approach Although the BODE index has proven to be useful, research has suggested that implementing use of the tool can be challenging, oftentimes proving to be impractical if patients are debilitated. Recently, Dr. Roberts and colleagues examined a simplified, quasi-BODE index and published their results in the American Journal of Epidemiology. “The spirometry test for measuring FEV1 to determine airway obstruction and the 6-minute walk test for measuring exercise capacity are not always easy to obtain, especially in patients who are not ambulatory,” explains Dr. Roberts. “A substantial percentage of patients are unable to complete either or both of these tests. In...
A Look at Recidivism in COPD Management

A Look at Recidivism in COPD Management

COPD is a group of progressively debilitating respiratory conditions, including emphysema and chronic bronchitis, and it ranks as the third leading cause of death in the United States, according to the CDC. About 16 million Americans are currently diagnosed with COPD, but another 14 million or more remain undiagnosed. In addition, COPD accounts for nearly 2 million ED visits each year, but much of this data is confounded by asthma admissions. “COPD patients who require ED attention or hospitalization are those with the most severe disease,” explains Reynold A. Panettieri, Jr., MD. “Furthermore, hospitalization and ED visits for COPD are more often clustered in the winter. They are associated with exposure to viruses and bacterial pathogens.” People aged 50 and older are more likely than others to get COPD, but the damage starts years before these individuals are diagnosed and can progress even after smoking cessation. Since the disease occurs and is diagnosed later in life, the risk of COPD is especially high for patients older than 45 with a smoking history. Healthcare Utilization & Readmission for COPD Most patients with diagnosed COPD report that symptoms of their disease impair their quality of life, but only about half take at least one daily medication for COPD. The healthcare utilization rate for COPD patients is also substantial. About one in five COPD patients visits an ED or is admitted to a hospital for care within a year. “The bottom line is that patients, providers, and the healthcare system cannot afford recidivism for COPD hospitalization.” Recidivism in healthcare has been defined as the tendency by ill patients to relapse or return...
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