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COPD: Coming to a Consensus

Approximately 24 million Americans have airway obstruction that is suggestive of COPD. With close to 125,000 annual deaths attributed to the disease, COPD now ranks as the third leading cause of death in the United States. Despite the disease’s wide scope, about 50% of patients are undiagnosed, largely because it’s underrecognized by the public. COPD progresses slowly, with early disease presenting with mild symptoms that patients learn to live with. Many COPD sufferers view their symptoms as a part of aging. Only few link them to smoking, the primary cause of the disease. Clinicians Play a Vital Role in Diagnosing COPD Despite recommendations from national guidelines, many clinicians throughout the U.S. do not utilize spirometry, an important tool in diagnosing COPD, because they feel it’s too time-consuming or expensive. This can lead to under-diagnosis, a problem commonly seen in the outpatient setting. Further complicating the issue is that many patients with COPD don’t receive a diagnosis until they are hospitalized from exacerbations that are usually triggered by infections. About 750,000 patients with COPD require hospitalizations each year. These patients tend to have poorer long-term outcomes than those diagnosed and treated effectively in the outpatient setting. Prevention of hospitalizations due to exacerbations through early diagnosis and treatment, smoking cessation, and increased awareness of COPD among patients and providers is important. 7 Key Recommendations for COPD There are several guidelines for COPD, including those from the American Thoracic Society, European Respiratory Society, American College of Physicians, and American College of Chest Physicians. In the August 2, 2011 Annals of Internal Medicine, my colleagues and I published a consensus that brings together...

Atrial Flutter: Current Concepts & Management Strategies

Typical atrial flutter (AFL), a condition which affects an estimated 200,000 new patients annually, has been defined as a pattern of regular tachycardia originating in the right atrium with an atrial rate of 240 beats/minute or higher. The current prevalence of AFL is high and is projected to increase considerably by 2050. Although not as common as atrial fibrillation, AFL can be a chronic condition. If left untreated, AFL can lead to debilitating symptoms, including shortness of breath, palpitations, dizziness, fainting, chest tightness, fatigue, and weakness. It can significantly impair quality of life and is associated with impaired cardiac output, atrial thrombus formation, and stroke. With proper treatment, however, AFL is rarely life threatening and symptoms can usually be managed effectively. “Atrial flutter is a common condition which should be treated appropriately to alleviate symptoms and prevent clot formation,” says Angelo Biviano, MD, MPH. Dr. Biviano adds that AFL in some patients can be associated with atrial fibrillation, and proper diagnosis and treatment is imperative. Research suggests that elimination of AFL may delay but not prevent fibrillation. Therefore, proper diagnosis and treatment of AFL is imperative. “The good news is that several treatment strategies exist for AFL,” says Dr. Biviano. “Consideration of patients’ medical history as well as their preferences will help guide treatment strategies for patients.” Identifying Causes AFL may be caused by abnormalities or diseases of the heart as well as diseases elsewhere in the body that affect the heart. These include diseases of the heart valves, especially the mitral valve, and chamber enlargement/hypertrophy. Diseases of the heart that have been linked to AFL include ischemia, atherosclerosis,...
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