Severe Chronic  Bronchitis  in Advanced  Emphysema

Severe Chronic Bronchitis in Advanced Emphysema

Studies have shown that chronic bronchitis occurs in 18% to 45% of patients with COPD and is associated with a higher risk for exacerbations and hospitalizations as well as an accelerated decline in lung function. However, chronic bronchitis has not been well described in patients with advanced emphysema. “The data regarding mortality in this patient population are conflicting,” says Victor Kim, MD. “Few studies have assessed the effects of chronic bronchitis on hospitalization rates in those with advanced emphysema.” A Novel Concept Severe chronic bronchitis is a novel concept, according to Dr. Kim, MD, lead author of a study published in the journal COPD that investigated this relationship. “We defined severe chronic bronchitis as the presence of cough and sputum along with chest trouble based on patient responses to the St. George’s Respiratory Questionnaire (SGRQ), a measure of health-related quality of life (HRQOL),” he says. Patients who had been randomized to medical therapy in the National Emphysema Treatment Trial were grouped by Dr. Kim and colleagues into those with or without chronic bronchitis. “The classic definition of chronic bronchitis is based on affirmative answers to questions about the presence of cough and sputum for 3 months out of the year for at least 2 consecutive years,” Dr. Kim explains. Participants were then categorized into those with severe chronic bronchitis or no severe chronic bronchitis based on the presence of chest trouble. Associations between chronic bronchitis and severe chronic bronchitis with all-cause mortality and time to all-cause hospitalization were assessed. Lung function and SGRQ scores over time were also compared between groups. Key Findings “Emphysema and chronic bronchitis are generally...

Drug Wars in the Exam Room

As physicians, we have all been faced with patients inappropriately looking for prescriptions for controlled substances. Some are looking to abuse them and some to divert them for profit. It is often hard to distinguish when a patient truly needs these medications or when they are just “drug-seeking.” More experienced doctors have a better sense of which patients are which. Drug-seeking patients often play on our emotions because they know we generally care about patients and may have difficulty turning down a request for opioids from someone in supposed pain. For years, patients have used many ruses to access these medications. Many of them “doctor shop,” use several pharmacies, or frequent various emergency rooms, making it difficult to track their prescriptions. And it’s much harder for a doctor to turn down a request from a new patient in acute pain than from one the doctor knows well and doubts. Having so many controlled substances available and sold on the streets has led to an increase in prescription drug dependency. These patients have a hard time breaking these addictions and often can only stop with help from special rehab programs. It has led to a further resurgence of IV heroin addiction and opioid deaths in many areas. As the states have tightened controlled substance prescriptions, they have become less available for diversion and are now a gateway drug to heroin—which is cheaper than prescribed medications. I am seeing teens in my practice addicted to IV heroin, a habit that started by raiding parents’ or relatives’ medicine cabinets. It has never been more imperative for doctors to step up and do...
Even in Medicine, There’s an App for That

Even in Medicine, There’s an App for That

The launch of the iPhone and Android smartphone platforms spurred a boom in medical application use, thanks to the ability to run much more complex medical apps at the point of care than earlier, text-based apps used on personal digital assistants, or PDAs. “Physicians can now explore disease pathology and review medical literature anywhere and anytime,” says Iltifat Husain, MD. “Physicians can use medical apps to enhance their own learning as well as teach patients at the bedside and improve the patient–physician relationship.” What’s the App Adoption Holdup? Despite the potential benefits, smartphone app use is far from ubiquitous among physicians. “Many physicians don’t know how to use mobile devices,” says Dr. Husain. “In some cases, physicians may be concerned that patients will look at them in a different way if they need to look up information. There is a stigma; patients expect their providers to be able to recall any medical information immediately and precisely.” “App use can actually introduce new information to the conversation.” Another stigma associated with smartphone app use occurs among colleagues. “There’s a concern among some physicians that they’ll give the appearance of being disengaged if they pull out their phone to use a medical app when conversing with colleagues,” Dr. Husain says. “The other way to look at these situations is that app use can actually introduce new information to the conversation.” Dr. Husain believes that time is the biggest barrier to overcoming these stigmas. “It’s mostly a generational issue,” he explains. “Fortunately, the incoming generation of physicians has grown up with computers. As this group moves from medical school or residency into longer-term...