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...
Safe Harbor for Docs  Who Follow Guidelines

Safe Harbor for Docs Who Follow Guidelines

Physician leaders are supporting a new proposed federal law that aims to reduce litigation against physicians, lower healthcare costs, and establish more fairness in the analyzing of malpractice claims. The new House bill, Saving Lives, Saving Costs Act, introduced by Congressmen Andy Barr (R-KY) and Ami Bera, MD, (D-CA) would create “safe harbor” – protection from liability – for physicians who follow best practice guidelines from malpractice suits. More than 75% of physicians face a malpractice claim over the course of their career—a liability climate that can drive patient care and encourage overutilization, adding billions of dollars in health costs each year. And patient outcomes don’t appear to improve as a result. If the physician being sued argues that he or she adhered to relevant, best practice guidelines, the case will be put in front of an independent medical review panel for investigation. If the panel determines that the clinician did comply to the guidelines or that the injury was not caused by failure to comply, the case will be dismissed. Personal injury lawyers are pushing back, one in particular claiming: “There is no evidence, however, that this safe harbor would actually promote patient safety. In fact, in Texas, where emergency room physicians have had immunity since 2003, patient safety has steadily decreased.” The Center for Justice and Democracy argues that clinical practice guidelines should not be used as a legal basis for determining negligence. The organization claims that there is already a general recognition that conflict of interest and specialty bias are ongoing problems in the development of clinical practice guidelines. Other concerns include the numerous, and sometimes contradictory, guidelines...